So what part of health IT has United left out…I can’t find anything with all the numbers of subsidiaries the own and now here’s a new group a medical billing clearinghouse targeted to integrate with Epic Medical Practice Management software systems.  As you can read they have the Netwerkes EDI system so they added on one more function to keep more money and profits in the medical billing/algorithm side of their business.  Everyone knows that Epic is a system built primarily for “large” hospital installations for medical records and you almost have to be a certain size before I believe they will sell to you.  I guess they liked the Epic algorithms and of course there’s money there. 

OptumInsight if I am not mistaken is the section of the group formerly known as Ingenix, the folks that Andrew Cuomo took on a couple years ago with the 15 years of short payments made to doctors that the AMA helped settle.  Here’s some other recent United news. 

United Healthcare Opens Retail “Employer Benefits” Store in Queens New York And Hires Former Minnesota US Assistant Attorney General As General Counsel

In some areas if you sign up for one of the United insurance programs, you basically get a hearing aid for free, which is distributed through yet one of more of their subsidiaries with being a zero co-pay.  United started yet another new division to market and sell the hearing aides. 

UnitedHealthCare Throws in Free Hearing Aids for Those Who Enroll In AARP Medicare Advantage, HMO & POS Plans in Miami-Dade County From Their New Subsidiary

I wonder how this is going to sit with several of the other clearinghouse businesses that work with all types of medical software?  There’s always the bank with over a billion on deposit worth a mention here under the Optum name. 

UnitedHealth Group Owns a Bank With Deposits Surpassing a Billion – OptumHealth Bank FDIC Insured

Another subsidiary can introduce a drug or device to the FDA and theoretically they have a subsidiary that can start the job and go all way down to what the doctor gets for reimbursement. 

United Healthcare (Optum) Owns A Consulting Firm for FDA Drug and Device Approvals, Clinical Trials–CanReg - Subsidiary Watch

On the clearinghouse action sometimes insurers pay part or all of the charges for this service that doctors use when submitting bills and I can maybe see some action coming in here with reducing what they might be an outside clearinghouse to draw more to “their” division.  Clearinghouses that are paid by insurers are always negotiating contracts with their services and they cut their reimbursements too and what happens then, the clearinghouse passes it on to the doctor or hospital.  What’s next in the Health IT end of this?  Will the Epic system carry some type of incentive to use this clearinghouse? 

I do wonder sometimes how there has not been any conflicts of interests with all the holdings of the company in so many different areas of healthcare, but I guess that could be the job of the new General Counsel mentioned above who was a former US Attorney.  BD 

OptumInsight recently launched new capabilities for its Netwerkes electronic data interchange (EDI) service, creating a smart clearinghouse that will help hospitals and physician practices – and particularly those using Epic Practice Management Systems – increase billing accuracy and productivity, reduce administrative costs and ensure timely receipt of payments from health plans.

OptumInsight and Epic have integrated the Netwerkes service with Epic Practice Management Systems claim administration and clinical information workflows, creating a unique set of advanced, productivity-enhancing capabilities for hospitals and physician practices that use Epic. For example, seamless communications between the two systems enables users to submit, track and manage eligibility checks, claims submissions and payments within Epic, rather than transfer files and toggle between separate applications.

  • Claim Error Reports, which map claims with errors to Epic's proprietary codes and automatically routes them to defined Epic work queues for corrections, eliminating delays and reducing the potential for human error
  • Submit Date Reports that provide a time-stamped report notifying users precisely when a health plan receives a medical claim, improving claim aging accuracy
  • Accepted/Rejected Claims Reports delivered in Epic's proprietary file format, saving time and improving accuracy because files are automatically reconciled within the practice management system
  • Remittance Management that automatically matches and routes remittance notifications to the appropriate billing system, ensuring payments are received by and posted to the appropriate Epic or legacy billing system
  • More Health Plan Eligibility Verification Options enable users save time by verifying an individual's coverage under health insurance for same-day visits in real-time; or, to prepare several patient files in advance of upcoming appointments in one transmission. Both methods transfer files in Epic's proprietary format, ensuring consistency and accuracy throughout the billing process.

"Netwerkes provides a ‘smart clearinghouse' from which physician practices, hospitals, labs, health plans, pharmacies and government agencies, can send and receive data, and helps to simplify and improve the accuracy of billions of health information transactions that occur across the health care system," said Tom Boehning, senior vice president at OptumInsight. "Further, integrating the Netwerkes clearinghouse more tightly with Epic, and embedding claims integrity services into the EDI workflow enable our clients to get optimal value from their investment in these systems."


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