Many billing companies across the USA have been relying on older systems with less automation and
more moving parts to perform RCM / Medical Billing activities for the roster of clients they have. One
such biller from California wanted to implement a secure, state-of-the-art, HIPAA-compliant cloud-
based system that can handle a handful of their clients effectively performing RCM workflow and
Payment Postings efficiently to handle their increasing customer base and claims volume. To meet
their requirements, expEDIum Medical Billing® (eMB) was chosen by this biller as a viable and cost-
effective solution. In addition, iTech was willing to make some customizations adding specific edits
and features that would reduce their billing pain points.
expEDIum Medical Billing® has exhaustive PMS / RCM features with a proven track record in improving
the payment reimbursement cycle from thousands of insurance companies (both Government and
Commercial) with transparency wherein users can track the claim history to determine where a given
claim is at a given point of time. eMB, as it is a standards-based product, supports many specialties,
including GI/ASC, Cardiology, Behavioural, Ambulance/EMS, Family/Internal Medicine, and public
health clinics, etc., and connects to multiple clearinghouses and MCOs for claims and insurance
eligibility inquiries. eMB currently uses Office Ally® and PhiCure® as the preferred Clearinghouses to
offer a complete end-to-end, seamless product with standards-based access to the clearinghouse.
expEDIum is currently being used by clinics and hospitals across various states in the United States of
America as most PMS/RCM systems were offering only the standard features with less agility towards
customizations, product enhancements, and extendable validation edits. This biller was searching for
a secure, cloud-based system that could accommodate their billing needs better than their older
legacy system, together with additional enhancements and billing requirements, and at an optimal
total cost of ownership. They required a system that could scale up and handle more patients and
process claims more efficiently, ultimately speeding up their revenue generation for their clients.
Our product offered the relevant features with exceptional customer support, open to making the
necessary custom modifications to meet their requirements. After more than a dozen conference calls
along with demos, cross walking of their legacy workflow to expEDIum workflow, and identifying any
immediate custom requirements, this customer signed up to subscribe to expEDIum. Please note that
this customer had only evaluated our expEDIum® product and went ahead with us after the 60-day
Challenges Customers Faced
As mentioned above, this biller was able to choose expEDIum as their preferred RCM / Medical billing
software based on a handful of parameters, including our ability to do customizations fairly quickly
and as the product covered many of the features they were looking for.
The following lists the various customizations and configurations iTech did for this biller:
- Ability to configure the client practice and other practices for which they handle billing/RCM
in a single expEDIum account and manage multiple billing provider/tax ID combinations from
a single login.
- Support of fee schedules with the Place of service (POS) (for office visit/professional claims)
and Facility Type (for hospital/institutional claims) dimension. This was implemented to ease
handling fee schedules that were wired differently based on the Place of service codes.
- Additional custom claim validation edits based on the billing provider, rendering provider &
service facility combinations. This includes payer-specific edits too.
- Customization of ESB Templates to have more fields for the specialties supported – This
included supporting all the dates available in the CMS-1500 claim form, Prior Authorization
fields, etc. This is to simplify their billing workflow and reduce data entry, thus providing
- Enhancement of Patient List to show more configurable fields.
- Enhancement to configure default Practice and Facility information in patient demographics.
With this, the ESB template itself would drive the facility and billing provider to which a given
patient is associated, thus providing billing efficiencies.
- Support for primary and secondary claim billing and reimbursement of claims for Medicaid,
Private/Commercial Payers, and Contract Payers.
- Support for Self-pay claims for patients not having insurance or inactive/expired/non-covered
- Real-time Insurance Eligibility Verification (IEV) – The system should be able to verify insurance
eligibility in real-time (in addition to batch eligibility) to increase the efficiency of the staff and
avoid rejections/denials at a later stage.
- Transparent Error, Rejection, and Denial Management of claims.
- Better secondary claim visibility and single button secondary billing. The system also supports
cross-over payment posting by auto-generating secondary claims and posting adjudication
details on secondary claims.
- Automation of EDI Claim Transactions and Auto-reconciliation of responses – The claims are
bundled in HIPAA X12N ready 837P, 837I EDI transactions and transmitted to clearinghouses
(even if the payer supports paper claims) in a scheduled automated mechanism, thereby
reducing manual efforts and overheads.
- Support for outsourced Paper claims printing and in-house printing as well.
- Support for manual and automated remittance advice (ERAs using HIPAA X12N 835 and EOBs)
- Invoicing Contract Payers – Feature to generate contracted payer invoices and payment
posting. This feature was enhanced for this customer to make the Address Type and Address
of the sender configurable.
- Configuring and using customized Ledger Transactions, standard transactions, and receipt
- Transparent Patient Billing/Statements and collection reports.
Reasons to Choose expEDIum Medical Billing for GI/ASC Billing
The customer made the decision to go ahead with expEDIum Medical Billing® after a series of demos
& discussions and after that, satisfactorily answering the questions and objections posed by the
customer, cost-effective claims-based pricing including a free tier wherein providers submitting less
than ten claims a month coming on board free of cost. The customer also used a 60-day free trial of
eMB to evaluate before coming on board in production mode so they could make an educated
How does the customer use the expEDIum Medical Billing® Product?
This customer has ramped up the volume of claims since inception several months back, and they
have completely moved out of their legacy system. This customer has 22 billing providers configured
in the system, with 53 rendering providers, 503 facilities, 641 referring providers, and 14 ambulance
facilities configured. They have 20 active billers/users using the system currently from different
geographies. iTech continues to interact with this customer to understand and address any further
pain points with periodic account management conference calls.
Here is the list of top 80% of the payers used by this biller, an exhaustive list almost had 500 payers.
Here is the payment delay summary with 90 percentiles of claims getting paid within 22 days of
Here are a few testimonials from this customer:
“....The more that you use expEDIum, the easier it becomes, and you get more understanding how it works. The one
thing I don’t care for is to look at multiple windows for just 1 account. On a side note, any question or concerns that
we have are taken into consideration and are be addressed, overall easy to use once you know the system.”
- Shirlene Loera, Senior Medical Biller
“.... expEDIum medical billing has a lot of potential, since we have been working with them, they have evolved to
meet a lot of our needs. Being able to attach the original EOB to send out to secondaries is very time saving. The
software people have been prompt about requests for adds into the system. Some of the issues with posting have
been addressed and we are working with them to make the system for us more user friendly. I look forward to how
this system will continue to evolve to meet our needs.”
- Kim Wright, Senior Medical Biller
“.... Overall, expEDIum is easy to use, with lot of potentials, IT customer service is great with responding back with
our question and concerns. We are very unique billing company with different specialties billing with close to 30
providers, expEDIum has done so much to meet our need. Love Working with all team members. Looking forward
with all the system upgrade they have for future to meet our needs.”
-Balwinder Bains, General Manager & Credentialing Coordinator
Remarkably, this biller has ramped up and efficiently processed over 62k claims and 280k+ HIPAA
transactions through eMB in just a handful of months. During this period, the total value of the claim
amount was around $12 million, and they successfully received reimbursements amounting to more
than $3.1 million.
*We do offer 60-days free trial for users who are new to our product. To learn more, contact us.