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A registrar is scheduling a patient by telephone while, in the background, the scheduling system verifies eligibility and determines benefit coverage for the requested appointment. Thus the registrar is able to inform the patient of payment up front.

A mirage? No longer.iEDeX™ MD is a seamless, integrated, eligibility and benefit verification solution that helps physician offices to confirm patient's insurance eligibility at the point of care. Historically verification was an expensive, costly, and impractical affair. The process typically involved web site look-up, fax or interactive voice response, or manually calling the health plan. iEDeX MD is integrated with the physicians practice management software and fully automates query of patient eligibility information during the scheduling process, removing the need to have someone manually query for the information.

EDeX MD Visibility

  • Insurance eligibility verification is among the fastest growing EDI transactions (health data management)
  • Providers using EDI could reduce eligibility verification labor costs by up to 50% (CORE Patient Identification Survey)
  • Health plans using EDI would also realize significant savings given that the average labor cost per call is $1.38 (CORE Patient Identification Survey)
  • Stanford University reports that 50% of its bad debt was attributable to bad eligibility data

As a further testament to the benefits of electronic transactions, Milliman, Inc. compared differences in the cost of manual and electronic transactions for a typical physician practice environment. The greatest savings occurred for those transactions where technology eliminates telephone time, such as eligibility verification and claim status checks, for which electronic transactions resulted in 80% to 90% cost reductions! (Electronic Transaction Savings Opportunities For Physician Practices, Milliman Inc.)


  • Eligibility inquiry is automatically generated from physician's appointment scheduling system
  • Eligibility response information is directly imported into HIS or EMR data fields
  • Immediate/real-time response
  • Supports medicaid, medicare, and commercial health plans
  • Permits user to perform inquiries on demand or in an automated fashion

Provides real-time information regarding:

  • Whether the health plan covers the patient
  • Whether the service to be rendered is a covered benefit (including co-pays, coinsurance levels, and base deductible levels as defined in member contract)
  • What amount the patient owes for the service
  • What amount the health plan will pay for authorized services
  • Coordination of Benefits (COB) information

Functional Values

  • CORE certified
  • HIPAA compliant
  • Ability to retrieve eligibility and benefits information via multiple search criteria
  • Provision to print the eligibility response
  • Automated, easy to use system requiring little manual intervention
  • Compatible with all major Health Information System (HIS) and Electronic medical Record (EMR) platforms
  • Ensures patient privacy by using encryption and security technology
  • Requires minimal IT staff time and system resources to install / maintain
  • 24/7 customer service

Provider Values

  • Provides real time access to eligibility data either by individual or batch
  • Saves time by replacing telephone intensive eligibility inquiries
  • Streamlines the electronic medical claim submission by ensuring that claims are submitted to the correct payer in a timely manner
  • Reduces bad debt / risk
  • Accelerates cash flow
  • Reduce / reallocate staff by removing manual processes
  • Ability to identify excluded benefits and determine benefits requiring pre-certification
  • Provides more detailed eligibility information than telephone responses

Patient Values

  • Improved customer service as staff can provide information to patients about their coverage and benefits
  • Confirm patient eligibility prior to office visit
  • Accurate identification of patient's financial responsibilities