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PacifiCare Health Systems Selects ENS, a subsidiary of NWH, for E-Commerce Services
  • Full-service, national health care e-commerce company to manage PacifiCare's claims and transactions
  • ENS offers HIPAA-compliant, front-end solution

New York, NY - January 23, 2003 - Electronic Network Systems, Inc. (ENS), a subsidiary of NWH, Inc. (NASDAQ: NWIR), announced that Cypress, Calif.-based PacifiCare Health Systems, Inc. (NASDAQ: PHSY), has selected ENS to provide services on claims to PacifiCare's health plans.

ENS' Pre-Adjudication Software System (PASS™) automates complex business rules and processes. PASS, which will initially be implemented in PacifiCare's expanding PPO business, will help streamline transaction flow, increase auto-adjudication, and eliminate duplicate claims, thereby helping to reduce associated costs.

"We found in ENS a partner that will help us more seamlessly connect our providers to PacifiCare and improve the company's administrative operations," said Ron Davis, senior vice president and chief administrative officer. "Over the past year, PacifiCare has made significant improvements to strengthen its operations, including increasing the number of claims that are auto-adjudicated. As one of our preferred vendor solutions, ENS will support our efforts to continue to improve our claims processing functions. We believe ENS' PASS™ will help us enhance our claim-submission process and simplify the administrative process."

CEO and President of NWH, Inc., and ENS Chairman Terrence Cassidy, stated: "PacifiCare chose to partner with ENS because we offer top-tier electronic solutions that deliver compliance with the full breadth of HIPAA-defined transaction sets. We are confident that ENS will enhance PacifiCare's initiatives to reduce administrative costs and facilitate re-allocation of these resources to other health care programs and services."

ENS' leading-edge health care transactions platform offers a single interface to conduct all HIPAA-defined transactions between payers and providers nationally, minimizing paper-intensive and labor-intensive processes.

Dean Politi, ENS Senior Vice President of Payer Services, said, "The robust functionality of our PASS ™ solution enables PacifiCare to utilize upfront claims pre-adjudication and help increase its adjudication rate while reducing errors and unwanted duplicates."

PacifiCare Health Systems Selects ENS, NWH subsidiary

Politi explained that PASS™ is tailored to meet the complex internal business logic of each payer to provide real-time eligibility verification with automated member and provider matching to the payer's host system records. "Any procedures manually interpreted by adjudicators today can now be automated by PASS™ with the added benefit of detailed transaction logging and audit reporting," he concluded. About PacifiCare Health Systems

PacifiCare Health Systems is one of the nation's largest consumer health organizations with approximately $11 billion in annual revenues. Primary operations include health insurance products for employer groups and Medicare beneficiaries in eight states and Guam, serving more than 3 million members. Other specialty products and operations include pharmacy and medical management, behavioral health services, life and health insurance and dental and vision services. More information on PacifiCare Health Systems can be obtained at www.pacificare.com.

About NWH, Inc. and ENS

NWIR was organized in 1993 as a holding and strategic resource company concentrating its resources on the acquisition, finance, development and management of telecom, healthcare services, technology and media businesses. Its principal operating subsidiary, Electronic Network Systems (ENS) (www.ENShealth.com) provides Internet and e-commerce connectivity between thousands of health care providers such as physicians, hospitals, clinics, practice management software vendors and third party commercial payers.

ENS is currently processing transactions annually from more than 200,000 providers. ENS provides services to healthcare providers and payers that eliminate paper and labor-intensive process in the administration of healthcare delivery. ENS provides and supports Health-e Network®, a full cycle suite of products and services designed to increase productivity, automate, and streamline workflow between providers and health care payer organizations.

Contacts:
PacifiCare
Cheryl Randolph
714.226.3441

Electronic Network Systems (ENS)
Dean Politi
Senior VP Payer Services
800.341.6141
dpoliti@enshealth.com

 
 

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