Higher Adjucation

Medical management services provider Premier Healthcare Exchange (PHX; Summit, N.J.) has teamed with CareVu Corp. (Lubbock, Texas), a clearinghouse for electronic data interchange (EDI) solutions, to offer cost-containment solutions to existing and prospective clients through a single-source, online platform. "Our model offers a comprehensive suite of services that can be automated through a single source, allowing insurance carriers, HMOs or TPAs to utilize all or some of PHX's services ... without the confusion of multiple vendors or data feeds in different directions," explains Neil White, national director of sales for PHX. The PHX services now are available through CareVu's .NET-based clearinghouse platform, a scalable, configurable system capable of leveraging XML technology to handle claims processing and HIPAA-compliant EDI services, according to the companies.

Under the PHX/CareVu program, healthcare organizations are required only to provide a single eligibility and claim data file in one format, which is scrubbed and analyzed by PHX/CareVu. The results then are passed to the payor, allowing the payor increased efficiency in streamlined medical cost management and reduced administrative costs related to claims processing. "We chose PHX/CareVu because it allows our company, through a single source, to implement multiple savings programs, eliminating the need for additional start-up fees and, more importantly, maximizing savings for our customers," says Paul Sabina, president, Insurers Design Administrators, an Oakland, N.J.-based independent third-party administrator.