Rising, WorkComp EDI Team on Billing Program

Rising Medical Solutions Inc. (Rising), a national medical cost containment organization, and WorkCompEDI, an electronic transaction clearinghouse company, recently established a relationship to process electronic billing transactions between healthcare providers and payers of workers' compensation claims.

Rising initially contracted with WorkCompEDI to implement a national clearinghouse solution in compliance with the eBilling requirements mandated by the Texas Department of Insurance. This mandate, effective January 2008, requires Texas healthcare providers to submit electronic workers' comp bills and attachments to insurance payers in a state-approved ANSI 837 format. In return, payers are required to electronically submit remittance advices to providers in an ANSI 835 format.

Subsequent to January, Rising and WorkCompEDI have deployed connectivity to Rising's payer clients in additional states. As eBill protocols are increasingly being standardized and adopted by various states, this alliance reportedly ensures Rising clients will have access to fully compliant and fully integrated electronic transaction services that meet the regulatory standards adopted in these new jurisdictions.

Addressing payers' complete workflow needs, Rising's eBilling solution includes receipt of electronic medical bill submissions, review and repricing of medical charges, provision of electronic explanation of reviews, processing of corresponding Electronic Remittance Advices (ERAs), and satisfying other mandated state reporting requirements. Additionally, Rising's capabilities include processing provider payments on behalf of its payer clients should they so choose.