4 ms·

The big companies all charge crazy expensive transaction fees: Emdeon, ENS (now Ingenix), ACS (now Xerox), Ability, Relay Health (formally HTP), and Meddata/Tra

The big companies all charge crazy expensive transaction fees: Emdeon, ENS (now Ingenix), ACS (now Xerox), Ability, Relay Health (formally HTP), and Meddata/Transunion. They all charge upwards for 25-35 cents per eligibility transaction. The software company I work for sells a healthcare product which includes automatic real-time eligibility verification. We don't charge per transaction. We can afford to do for two reasons 1) we put a lot of effort into finding cheap/free/redundant real-time connections to payers and 2) we can simply eat the cost as part of the margin for our product. Our philosophy is that you should check eligibility often and always, at every point of the patient's encounter from scheduling to check-in. Per transaction costs scare away customers which is part of why we don't charge per transaction.

DennisP 14y ago
Wow. It's so weird seeing Meddata mentioned and described as one of the "big companies." I was Meddata's second programmer, and built their eligibility system. I wrote their edi parser in five pages of C# code. Two of us built an entire eligibility and referral system, and took the company from nothing to profitability in five years. Then I moved on. I still visit them from time to time, and although Transunion owns them now, the Meddata team is still pretty small.
- daigoba66 14y ago
  That's pretty crazy. I think I consider Meddata to be such a big player because of their extensive payer list. Also, we use Meddata as a "backup" route for when our more direct (and free) connections are unavailable. I'm curious to learn more about the history of the company. From my experience the software isn't necessarily the hard part. The hard part is setting up all of the trading partner relationships with payers and other clearinghouses/vendors.
  - DennisP 14y ago
    Yep, that was the hard part. Our sales team was three people, including the CEO, and they also had to sell the product to providers. Somehow they managed. We actually started with referrals. Providers were filling out paper forms and faxing them. Every payer had its own rules, its own identifiers for providers, its own forms. We put everything on a website and reduced a ten-minute process to thirty seconds. We got our first paying customers in 1999. Trouble was, support was killing us. By 2001 it was starting to look like we wouldn't make it. Then we added eligibility, and it turned out to be insanely profitable. We started by getting payers to give us their entire customer lists, then added edi, plus some proprietary APIs some of them had. At that point, HIPAA hadn't fully kicked in and payers were still implementing X12. In 2003 we started to break even, and I moved to our parent company to start another project. Meddata bought a couple other companies, then a couple years ago Transunion bought Meddata. I don't know for how much, but Meddata was making a lot of money by then with a team not much bigger, so it had to be a lot.
    - kategleason 14y ago
      Very cool Dennis, I'd love to connect with you to hear more about your experience. Please email me k@eligibleapi.com

DennisP 14y ago

Wow. It's so weird seeing Meddata mentioned and described as one of the "big companies." I was Meddata's second programmer, and built their eligibility system. I wrote their edi parser in five pages of C# code. Two of us built an entire eligibility and referral system, and took the company from nothing to profitability in five years. Then I moved on. I still visit them from time to time, and although Transunion owns them now, the Meddata team is still pretty small.

daigoba66 14y ago
That's pretty crazy. I think I consider Meddata to be such a big player because of their extensive payer list. Also, we use Meddata as a "backup" route for when our more direct (and free) connections are unavailable. I'm curious to learn more about the history of the company. From my experience the software isn't necessarily the hard part. The hard part is setting up all of the trading partner relationships with payers and other clearinghouses/vendors.
- DennisP 14y ago
  Yep, that was the hard part. Our sales team was three people, including the CEO, and they also had to sell the product to providers. Somehow they managed. We actually started with referrals. Providers were filling out paper forms and faxing them. Every payer had its own rules, its own identifiers for providers, its own forms. We put everything on a website and reduced a ten-minute process to thirty seconds. We got our first paying customers in 1999. Trouble was, support was killing us. By 2001 it was starting to look like we wouldn't make it. Then we added eligibility, and it turned out to be insanely profitable. We started by getting payers to give us their entire customer lists, then added edi, plus some proprietary APIs some of them had. At that point, HIPAA hadn't fully kicked in and payers were still implementing X12. In 2003 we started to break even, and I moved to our parent company to start another project. Meddata bought a couple other companies, then a couple years ago Transunion bought Meddata. I don't know for how much, but Meddata was making a lot of money by then with a team not much bigger, so it had to be a lot.
  - kategleason 14y ago
    Very cool Dennis, I'd love to connect with you to hear more about your experience. Please email me k@eligibleapi.com