Pharmacy & Laboratory

Any organization within the greater healthcare industry umbrella has a need to deal with the HIPAA Transaction Sets. From the smallest agency, to the largest healthcare delivery system, users all over the country are utilizing the Power Tools Suite from EMS.

“We use both the Response File Reader and the EDI Toolbox daily. Frequently, our payors don’t pay as expected and it is critical that we can determine what was actually paid. The EDI Toolbox allows us to see what has been paid, and more importantly what hasn’t been paid on a script by script basis. The Response File Reader has been helpful for looking deeper into the claims to see the why claims were adjusted, to look at what was adjusted, and to determine what the patients copay is, if they have one due at all. Prior to purchasing these two pieces of software, we were trying to make these determinations by hand, which was incredibly time consuming and unproductive. Thank you for helping our processes become more efficient and more importantly, improve our accuracy.”

Ginessa Bradley, Senior Analyst
3B Group / Merwin / Robin Drug Company, New Hope MN

“At our organization, we post 95% of our payments electronically at the CPT code level. We would not be able to do this without the use of EMS’s Response File Reader (RFR) tool.  The tool allows us to quickly review payment/denial data at both the claim and line level detail. We can easily identify split CPT code payments/denials from a payer due to MUE edits at the line level detail; identify claims that Medicare crossed over to a secondary payer; identify secondary payments, recoupments, reversal of payments and/or payments for corrected CPT codes and payments from an HRA account; and identify what the patient’s deductible, copay or coinsurance responsibility is.

The reports from RFR provide an easy way to manage your data files, as well as provide some additional information that may not be able to from other remit readers. RFR provides the ability to export your remit into Excel and create work-lists for your denial management staff to work. The EDI Utility Toolbox allows you to join several remit files of data into one large file that can then be imported into RFR for reimbursement analyses or to create a larger work-list for your staff. We would not be as successful as we are at posting our remits electronically if we did not have RFR to assist in that process.”

Ginny McGovern, Manager of Accounts Receivable

Clinical Pathology Labs, Austin TX