ATLANTA, June 19, 2007 (PRIME NEWSWIRE) -- MedAvant Healthcare Solutions (MedAvant) (Nasdaq:PILL), a leader in healthcare technology and transaction services, today announced the launch of its front-end gateway solution for insurance payers.
The comprehensive package includes pre-receipt fraud and abuse detection, clinical code editing, claim aggregation and real-time research tools. Payers can use the complete package to shorten their claim turnaround time or choose individual services to complement their existing tools. MedAvant solutions occur before the payer receives the claim for adjudication, which is referred to as the "front-end" of the claim payment process.
"Several companies offer gateway management for payers, but we believe our front-end combination of services is unique," said John Lettko, MedAvant president and CEO. "Payers which let us aggregate and scrub their claims before they receive them will realize significant savings in both man hours and incorrect or unwarranted payments. We can do this without requiring changes to infrastructure or jeopardizing relationships with other clearinghouses, so there is no risk to payers."
According to the National Health Care Anti-Fraud Association website, at least 3 percent of healthcare expenses are outright fraud. Others estimate the loss at 10 percent or $170 billion each year. Many insurance payers do not check for fraud until after the claim is paid, and at that point funds are nearly impossible to recover. MedAvant's front-end solution will screen claims for fraud and abuse before the payer receives and pays them. With MedAvant's real-time technology, this process happens quickly and does not impede prompt payment initiatives.
Clinical code editing screens claims for mistakes such as services that were inappropriate for the patient's age or gender or services that were not necessary for the diagnosis. Such issues can bottleneck payers' adjudication systems. MedAvant's solution edits the codes in real time before the payer receives the claims so payers' adjudication systems are automatic.
Single source claim aggregation allows a payer to route all claims through MedAvant's Phoenix(sm) technology. Routing all claims through one repository means the claims are subject to identical pre-adjudication steps, and the data can be more easily researched. The system uses multiple real time processing engines and includes a second data center for automatic roll-over in the event of a disaster.
With all claims aggregated together, payers can use MedAvant's portal, called myMedAvant, for business intelligence. The portal allows payers to drill down to claim detail level on individual claims as well as schedule routine reports or generate custom reports on demand. Payers can also private-label the provider version of the portal to make similar claims submission and research tools available to providers.
The front-end gateway solution will be introduced at the 2007 Institute for America's Health Insurance Plans June 20-22 in Las Vegas. For more information, see www.frontendgateway.com.
About MedAvant Healthcare Solutions
MedAvant provides information technology used to process transactions within the healthcare industry. MedAvant offers electronic claims processing to healthcare providers, a Preferred Provider Organization called the National Preferred Provider Network (NPPN(tm)) and remote reporting solutions for medical laboratories. To facilitate these services, MedAvant operates Phoenix(sm), a highly scalable platform which supports real-time connections between healthcare clients. For more information, visit http://www.medavanthealth.com. MedAvant is a trade name of ProxyMed, Inc.
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Forward Looking Statement
Statements in this release that are "forward-looking statements" are based on current expectations and assumptions that are subject to risks and uncertainties. In some cases, forward-looking statements can be identified by terminology such as "may," "should," "potential," "continue," "expects," "anticipates," "intends," "plans," "believes," "estimates," and similar expressions. Actual results could differ materially from projected results because of factors such as: the soundness of our business strategies relative to the perceived market opportunities; MedAvant's ability to successfully develop, market, sell, cross-sell, install and upgrade its clinical and financial transaction services and applications to current and new physicians, payers, medical laboratories and pharmacies; the ability to compete effectively on price and support services; MedAvant's ability and that of its business associates to perform satisfactorily under the terms of its contractual obligations, and to comply with various government rules regarding healthcare and patient privacy; entry into markets with vigorous competition, market acceptance of existing products and services, changes in licensing programs, product price discounts, delays in product development and related product release schedules, any of which may cause revenues and income to fall short of anticipated levels; the availability of competitive products or services; the continued ability to protect the company's intellectual property rights, implementation of operating cost structures that align with revenue growth; uninsured losses; adverse results in legal disputes resulting in liabilities; unanticipated tax liabilities; the effects of a natural disaster or other catastrophic event beyond our control that results in the destruction or disruption of any of our critical business or information technology systems. Any of these factors could cause the actual results to differ materially from the guidance given at this time. For further cautions about the risks of investing in MedAvant, we refer you to the documents MedAvant files from time to time with the Securities and Exchange Commission, including, without limitation, its most recently filed Annual Report on Form 10-K. MedAvant does not assume, and expressly disclaims, any obligation to update information contained in this document. Although this release may remain available on our website or elsewhere, its continued availability does not indicate that we are reaffirming or confirming any of the information contained herein.