Managed Care that Works for Everyone
Prime Network Provider Spotlight
PALMETTO GENERAL HOSPITAL

HIALEAH, FL
   Frequently Asked Questions
Asked by Clients/Brokers...
Who is Evolutions Healthcare Systems (EHS)? EHS is one of the largest independently owned nationwide Preferred Provider Organizations PPO). We contract with Hospitals, Physicians, and Ancillary providers to create a superior network of healthcare professionals that strive to deliver exceptional service at extremely competitive rates. Our state of the art claims management software, TRX-Transaction Re-pricing & eXchange architecture, has been designed to ensure timely and accurate claims processing. For additional information see About Us.

Does EHS have national network coverage? EHS provides access to more than 600,000 providers through our Prime Plus Network, Select Network, or Select Plus Network covering all 50 states, District of Columbia and Puerto Rico. Up-to-the-date information on specific providers may be obtained using our Provider Search.

What sales functions does EHS offer? EHS assigns each client an Account Executive and an Inside Sales Associate to assist in your sales and customer support requirements. Our Inside Sales Associates may be called on to provide you with network coverage (GEO) reports, disruption reports, CPT analysis, account directory services, or customer enrollment. Our Account Executives and EHS Management are available for on-site visits, and to help develop your strategic initiatives.

Why should I choose EHS as my PPO Network? EHS offers one of the largest preferred provider networks available to meet your every need from primary access to cost containment solutions, all at substantially negotiated discounts. Additionally EHS makes it easy for our clients to do business with us...

Our multiple network products and services can be custom tailored to fit your employer group, product, or plan design requirements with exceptional coverage and discount rates.

Our on-line and automated claims processing and repricing solution, TRX, provides for electronic claims management & reporting, offering the best time service in the industry.

We keep clients fully informed by use of our electronic web portal, quarterly performance reports, “Hurricane Flag” for risk notification, and through TRX, offering clients 24x7 claims processing and status inquiry services.

For Coverage, Performance, Service, & Savings . . . Choose Evolutions!

For additional information see About Us.

What is TRX? TRX, including TRXpass, TRXchex, and TRXport, provide key services for electronic claims management, repricing, reporting, and claims status. For additional information see TRX, or contact Sales & Marketing for a demonstration of TRXpass (Web repricing), and TRXchex (Claims & EOR Imaging and Status).

Does EHS accept claims electronically? Yes, EHS is extremely flexible in our ability to manage electronic claims. TRXport, is fully HIPAA compliant with respect to the transmission of both professional and institutional claims. Per the HIPAA mandates, EHS utilizes ANSI X12 837/4010 standards for professional (HCFA1500) and institutional (UB-92) claims. Providers may submit claims directly to the secure TRXport FTP site for processing (EHS does not accept claims from clearing houses). For more information see TRXport

What if I want to process the claims myself? Our TRXpass system gives clients the ease of processing their own claims on-line with no waiting. For more information see TRXpass. To arrange for a demonstration contact our Sales Department.

How does EHS ensure the security of transmitted claims data? EHS utilizes the PGP Public Key Encryption system. This system provides up to 4096 bit file encryption, exceeding any and all federal mandates or HIPAA requirements and is extremely cost efficient.

How can I get more information about Evolutions Healthcare Systems? If you would like to receive additional information please contact our Sales & Marketing Department