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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