Peek into the records room of a typical doctor’s office and you’re likely to notice a sea of paper. Larry Lai sees an ocean of opportunity.
Lai, chief executive of EDIComm Inc., has developed software that streamlines the medical claims process by simplifying billing and collection operations.
The Woodland Hills company works with 600 different insurers considered a strong selling point in this confusing era of managed care. Plus, doctors and hospitals can integrate the software into their administrative systems regardless of the computers or software they are currently using.
“They have an outstanding product. They have exceptional customer service, and they’re willing to customize the product to meet the needs of our organization,” said Gigi Wallin, director of business services at St. John’s Regional Medical Center and St. John’s Pleasant Valley Hospital.
Typically, doctors and hospitals file insurance claims using a different form for each different insurance carrier. They must do a visual check of each form to make sure the information is complete and, when payments come in, they must manually check them against the individual claim for each individual patient and insurance carrier.
For every 100 patients a doctor treats, there might be 50 different kinds of insurance claim forms to file different pieces of paper, different payments to track down and any number of chances that something will go wrong. With large volumes, it can take weeks to manage the paperwork on a single claim.
With EDIComm software, the same electronic form is filled out for each patient, regardless of coverage or insurance carrier. The information is then sent to EDIComm, either over a proprietary line or over the Internet, and EDIComm translates it to the format required for the particular insurer.
If information has been omitted, EDIComm notifies the health care provider the next day. And when payments come in from each insurer, EDIComm consolidates them on a single statement and transfers them back to the provider. EDIComm provides eligibility information by computer, so a doctor can tell the type of coverage a patient carries and what services will be covered.
“The biggest benefit is that it’s not just a billing tool,” said Mike Lozano, administrative analyst with UCLA Health Care Enterprise. “We’re able to take the data EDIComm provides and generate feedback and reports.”
Lai, who started the business three years ago, chose to focus on health care because of the vast need for data services. “I did a little market research, and I saw that the health care industry is huge,” said Lai. “Compared to retail, it’s like a pond compared to an ocean, and I wanted to catch fish in an ocean.”
This year, Lai says revenues will reach $5 million and he expects to turn a profit. Because most of the expense of setting up the system is now behind him, earnings are looking good. “When I double the business, I don’t need to double employees,” Lai said. “It’s like a freeway. Once it’s done and you put in a tollbooth, every time a car passes you get paid.”