We are here for you.
Our services.
HEALTH PLAN ADMINISTRATION
EHS offers our clients a truly unique white-glove approach to customer service. We never stop innovating and strategically adjusting your plan to ensure it functions at its highest potential, making the most of every dollar spent and every life covered.
Claims Management & Adjudication
Claims Repricing
Billing & EDI Management
ID Card Management
Dental & Vision Administration
PBM Management
Plan Document Design
Vendor Stack Management
Member Education & Navigation
TECHNOLOGY DRIVEN
Technology is at the heart of Edison as we have invested heavily in fully integrated platforms; increasing our functionality and reliability to offer worry-free Benefits to your members.
1-to-1 reporting; where data conversions cease to exist
No lag time with real-time and daily data updates
Fully integrated progressive Mobile App
We are built on PowerBI: utterly scalable & insanely fast
Free customized reporting
Direct reporting control for clients
Real-time view of accums, EOBs, ID cards, etc.
10 systemwide enhancements per year
Quality metrics built into our reporting
esri mapping brings your data to life
Direct Member Text Notifications
CENTERS OF EXCELLENCE
We embedded Edison Healthcare, our sister co. which built a private network of America’s top medical teams at some of the best medical centers in the nation. Each SmartCare Center and surgical team is selected for their excellence in dealing with these covered diagnosis types:
Spine (Back & Neck)
Orthopedic & Joint (Shoulder, Knee & Hip)
Cancer
Heart & Valve
Bariatrics
Transplants
Complex Care
CARE NAVIGATION
Our highly experienced member services specialists are true advocates for your members’ healthcare. They passionately work with members, their families, and their physicians to coordinate the highest-quality, cost-conscious healthcare, resulting in the best possible patient outcomes.
Pre-Admission Certification
Outpatient Pre-certification
Reconsideration & Appeal
Inpatient & Concurrent Review
Case Management
Discharge Planning
Retrospective Review
Provider Channeling
CUSTOM NETWORK DESIGN
Edison can build specialized network options to support clients and their members with more control over options in local markets. Our teams work with providers, hospitals, and all other medical facilities to negotiate contracts and provide cost controls with higher quality and greater savings.
Imaging (MRI, CT, PET) & Labs
Physical Therapy
Surgical Procedures
Chemotherapy & Radiation
Home Health Services
Maternity
DME
VIRTUAL MEDICINE
EHS has made progressive moves into virtual and technology driven remote access to medicine for years. We see that this is going to be an increasingly large part of the future of medicine for everyone. And doing this right by helping members learn to connect with local PCPs, on-call nurses & doctors, plus SmartCare specialists - will save the health plan significant funds all while helping make better medical decisions for the patients.
Services 24/7
Virtual SmartCare Center Visits (COE)
Edison Evolution Local PCP Virtual Access
Virtual PBM Advising
Nurse Navigation
Chronic Care Management
