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TWST: We would like to begin with a brief historical sketch of National
Healthcare Exchange Services and a picture of the things you are doing
right now.
Mr. Rieger: National Healthcare Exchange Services has always been a
public company and began development of its current business model in
late 1999. We are currently non-reporting. Our primary business model is
to provide turnkey solutions to the healthcare industry that improve
satisfaction with the payment transaction between medical providers and
payers. We have three products that we currently market. First is our
premier product called eobResolve_. This is an audit solution that
allows providers and payers to resolve payment disputes more
efficiently. Second is claimResolve_ that is a front-end scrubber for
the medical provider's claim to ensure it complies with the health
plan's coding requirements. Finally, we also provide re-pricing services
for the healthcare industry, including a product for the consumer-driven
market to allow point of service pricing. TWST: How large are the problems or issues that you address?
Mr. Rieger: That's an interesting question because, if you're familiar
with some of the recent history regarding tensions between medical
providers and health plans, in our view the marketplace is clearly
looking for a more satisfactory solution. Nearly all of the largest
health plans in the country have been sued under the RICO act by a class
that included 600,000 practicing physicians. Most have reached
settlements or are in the process of doing so, but a centerpiece of the
complaint has been the excess complexity and lack of transparency in
business rules used by payers to pay claims. Providers have been
frustrated because they lack the technology and access to business rules
necessary to cost effectively police small differences in payment. We
have a technical solution to resolve these differences between the
trading partners in a much more efficient manner. The net of this is to
lower the cost to handle disputes on the part of the payer and to
increase the satisfaction with the level of accuracy and payment on the
part of the provider. There are a billion transactions in the medical
provider market and there is a great deal of evidence that shows that
the level of satisfaction around time and accuracy is nowhere near what
it could be or should be, given the volume of transactions and the
dollars at risk for both parties. Our interest is to bring the
healthcare industry ' particularly the payment of a healthcare claim '
up to a much higher standard; one that the financial industry has
enjoyed for 50 years. Health care, in particular, is way behind the
curve in terms of employing standard business practices that ensure a
much higher level of accuracy and satisfaction to the trading partners.
Tickers included in this excerpt: NHCR
For more information call (212) 952 7433. The
Wall Street Transcript does not endorse any of the comments made by interviewees, and does
not make stock recommendations.
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