The driving force behind moving the workers compensation, auto and personal injury markets into the electronic age: WorkCompEDI

“Renowned for implementing “out of the box” solutions which are pioneering to an industry where payor and bill review customers can work with a firm to explore new ways to drive their operational goals through an aligned partnership, WorkCompEDI has solutions for any party that seeks to exchange billing and general healthcare information between providers, payors and vendors in the work comp, auto & personal injury market”

Meet Marc Menendez, a pioneering force in the healthcare services industry since 2000 and a serial entrepreneur, having launched and sold numerous startups as well as acquired struggling companies and returned them to profitability and market impact status. He serves as President & CEO of WorkCompEDI. Along with Senior Vice President, Brendan Friar who brings extensive experience in implementing and streamlining internal operations and interconnectivity for leading organizations, he has fostered innovation and ensured profitable growth, expanding the pursuit of the nearly paperless organization. With offices in NYand IL, WorkCompEDI has created a robust market value for itself since inception in 2006.

Tracing the roots
“WorkCompEDI is Currently the leading clearinghouse to the work comp, auto, and personal injury markets, bringing together payors, providers and vendors to promote the open exchange of EDI for accelerated revenue cycles to lower costs and increase operational efficiencies. We offer an array of flexible advances transaction services to meet our clients’ individual needs. In fact we have just started launching our “Advanced Transaction Services” into the market, which provide electronic, two-way communication capabilities to the industry which in the past were handled exclusively by paper or human involvement (telephone, fax , other). These services and our keen focus on driving the market towards electronic, two-way communication helps clients and partners remain focused on their respective growth and customers, while helping drive a mutually aligned and successful relationship”, said Marc.

In 2001, when Marc joined a group of investors to acquire a fledging but pioneering real-time claims processing technology company out of bankruptcy , who knew that decision would end up impacting the future of many other markets. From that impactful acquisition and over the next eight years Marc and his team transformed the small but pioneering technology firm into the dental EDI industry’s largest real-time claims clearinghouse vendor, paving the way for what is today known as WorkCompEDI. In 2005, WorkCompEDI was conceived and launched through the development of a state-of-the-art technology platform from which was meant to provide a turnkey EDI solution to the still highly paper driven, inefficient, labor intensive and error-prone process of receiving and adjudicating workers compensation bills. As of December 2015, WorkCompEDI is the largest EDI clearinghouse vendor in the work comp, auto and personal injury markets, offering submitters over 2,900 electronic delivery channels, while processing more than 20 million transactions annually which represent over $5 billion dollars in healthcare service delivery fees.

Plans for the days ahead
From providers such as doctors, hospitals, clinics, billing companies, to payors like insurance plans, bill review firms, employer groups, TPAs and connected through vendors that include practice management software vendors, clearinghouses, EMR vendors, PPO networks, WorkCompEDI has solutions for one and all. Its breadth of electronic connectivity and its ability to process all transactions for submitters (EDI or paper delivery processing) all-Payor service capability gives it tremendous flexibility in custom workflows and service delivery capabilities which is critical in delivering a value adding service to any industry.

Additionally, its advanced pioneering transaction services that are aimed at converting typically paper and telephone/fax transactions into electronic exchanges(outside of traditional eBilling), makes it the undisputed and leading solution for helping the work comp, auto and personal injury markets move into the electronic age.

The most appealing and beneficial services offered by the company are the highly efficient two-way communication channels that now exist with WorkCompEDI’s 2,900 electronic connections. Through its web systems (iCompEDI®, dtmEDI™ and IMSLink™) along with integrated partnerships with leading practice management software (PMS) and clearinghouse vendors, the healthcare industry has immediate interactive access to efficiently process billing and exchange timely information.
“However, the biggest “technical” challenges to higher EDI adoption is the ongoing conversion projects by leading insurance plans and bill review companies to upgrade their backend processing platforms, which continue to delay integrated connectivity for accelerated communication between parties. Other technical challenges of the industry include ongoing integration delays by leading practice management software (PMS) / electronic medical record (EMR) and group health clearinghouse vendors, while the biggest “business” challenges include the lack of widely adopted use of electronic secondary bill review transactions (vs paper), the lack of submitters in the market willing to use electronic connectivity access when it exists, the delays in state jurisdictions implementing EDI mandates and ongoing bad faith actions or tactics that are frivolous or intended to cause delay in the workers compensation market – all which can be resolved through the use of electronic, two-way communication amongst parties”, added Marc.

SUCCESS STORIES
WorkCompEDI’s clients are highly satisfied with the products and services provided.

• US Healthworks has achieved an EDI rate of 78% for billing delivered through WorkCompEDI in the state of CA.
• WorkCompEDI’s submitters have access to over 2,900+ electronic routes and in the cases where WorkCompEDI is unable to deliver billing electronically, billings are printed & mailed for no extra charge (and an IntelligentMail tracing number – like a UPS/FedEx tracking number is included, that gives clients the ability to track their mailed transaction through the USPS system).
• WorkCompEDI’s payors and bill review firms are able to implement unlimited pre-adjudication scrubbing and validation with its clearinghouse to ensure only the cleanest billing is delivered.

“Next up for WorkCompEDI?  Electronic payments through its vast network of customers and partners through its WorkCompPay™ services set to launch in 2016.”