Managed Care that Works for Everyone
Prime Network Provider Spotlight

   About Us
Evolutions Healthcare Systems, Inc.
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 is committed to providing a quality managed care solution that benefits everyone...

Competitive reimbursement and fast payment of claims.

Increased patient volume through our national marketing efforts and directed plan design.

Enhanced market exposure through your listing in our directory, Provider Search, including a link for your provider web site.

Ease in claim processing. TRXport accepts claims from providers in a variety of standard and custom formats. This simplifies claims processing, eliminates the need for clearing houses and does not require the purchase of special software in order to do business with us.

A dedicated Provider Relations Department to help meet your specific needs.

Where do I send claims? EHS accepts claims using a variety of formats and secure methods including via mail, FAX, email, EDI, or via the Web. To facilitate rapid processing and payment, providers may submit claims electronically to the secure EHS FTP site (EHS does not accept claims from clearing houses). Paper claims should be sent to Evolutions Healthcare Systems, unless otherwise directed. Please refer to the back of the patient's ID card for claims routing instructions.

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, or contact Provider Services.

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

Who pays claims and when will I receive payment? EHS represents over 250 payors nationwide. Claims are re-priced according to the contracted reimbursement rate within 24-48 hours and then forwarded to the Payor for adjudication and payment. EHS requires its Payors to reimburse in-network providers within thirty (30) days of receipt of a 'clean claim'.

Do I need to use referrals? We are an open access network and do not utilize gatekeepers. However, some of our plans may use a referral system for specific services. Please contact the Payor by calling the benefits and eligibility number on the patient's ID card for specific requirements, however whenever possible you should refer patients to an Evolutions Healthcare Systems participating provider. The network participation status of colleagues or potential referrals may be found using our Provider Search or by contacting Provider Services.

How often is the directory updated? The EHS PPO Online Directory is connected to our “live” provider data repository. Changes to provider records are made available immediately following any update. You may search our online directory at Provider Search or contact Provider Services.

My participating provider agreement is with Guardian Resources, are you the same company? Yes, on September 1, 1998 we changed our name from Guardian Resources, Inc. to Evolutions Healthcare Systems, Inc.

Does my participating provider agreement with Guardian Resources need to be assigned? No, your participating provider agreement with Guardian Resources, Inc. is still valid; assignment is not necessary.

How do I notify EHS of an address change or tax identification number change? To ensure a timely and smooth transitions of information, EHS requests notification at least 60 days before an office relocation or a change in tax identification number and at least 90 days before closing your practice. Simply complete the required information on our Provider Update form. If you have further questions please contact Provider Services.

How do I add a new practitioner to my participation provider agreement with EHS? Updates may be made using our Provider Update form. If you have further questions please contact Provider Services.

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