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Sutter Connect selects NHXS to Audit and Collect Underpaid Claims
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| | Sacramento, CA December 20, 2005
Sutter Connect selects NHXS to Audit and Collect Underpaid Claims
National Health Care Exchange Services, Inc (OTC: NHCR.pk), headquartered here, said today it signed a contract with privately-held Sutter Connect Inc., a leading health care management and administrative services company that manages more than $975 million in receivables and managed care services each year, to assist Sutter in identifying, analyzing and collecting underpaid claims.
NHXS Inc. has developed a proprietary ASP based repricing engine called eobResolve to comprehensively price, audit and automatically appeal healthcare claims. The company’s software provides a turnkey solution which determines if remittances are in compliance both with fee schedules and other payment rules employed by each payor. Appeals are automatically generated and delivered to the appropriate payor. eobResolve also identifies late payment interest and overpayments.
Sutter Connect, also based in Sacramento, provides services to over 410,000 members from more than 30 health care organizations and is affiliated with Sutter Heath, the largest non-profit provider of health care services in Northern California. (http://www.sutterconnect.org)
According to Mark W. Rieger, CEO of National Health Care Exchange Services, Inc. “Based upon preliminary work on behalf of Sutter over the past four months, as well as our efforts on behalf of additional NHXS Inc. clients, we have established that 5-10% of all health care claims, adjudicated by health plans, are underpaid. We believe these underpayments are systemic and universal among providers”.
Rieger said that while the dollar value of these underpayments is “substantial”, until now “the complexity and the cost of audit and recovery have made it impractical for health care providers to undertake the effort.”
Both NHXS Inc. and Sutter Connect officials declined to comment on the dollar value of underpaid claims at Sutter, or the revenue expectations for NHXS, stating that the data was still “sensitive”. “Nonetheless,” Rieger predicted that the Sutter program would be “widely followed by other health care providers across the country.”
”By offering organizations like Sutter Connect and their clients a turnkey solution, we believe a more satisfactory method for dispute resolution can ultimately be achieved, with major benefits for health plan payers as well as for providers” Rieger said.
The company said it was in advanced discussions with several potential clients including a number of organizations as large as and larger than Sutter, and that it was adopting a flexible approach in contract negotiations aimed at finding the best way for NHXS Inc. and for its clients to maximize the economic benefits of the eobResolve engine.
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