Payor FAQ

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 Repricing & 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 NetworkSelect 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 to assist in your sales and customer support requirements. Your Account Executive may be called on to provide you with network coverage (GEO Access) reports, disruption analysis, CPT analysis, account directory services, or customer enrollment. As part of our concierge level service and custom network development, the EHS team is 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. 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 additional information please contact Sales & Marketing

What is TRX?

TRX makes Evolutions Healthcare Systems your One Stop Claims Shop.

All of our EHS solutions are powered by TRX (Transaction Re-pricing & eXchange) service architecture.

TRX, developed by EHS over the past 20 years, offers an open-architecture, HIPAA compliant, claims management and E-business solution for automated claims management, repricing, reporting, claims status, transaction routing, and EDI services.

Contact Sales & Marketing for additional information or a demonstration of TRXpass, our Web repricing portal.

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 837/5010 standards for professional (HCFA1500) and institutional (UB-92) claims. For more information see TRXport.

How does EHS ensure the security of transmitted claims data?

EHS utilizes the SSH File Transfer protocol (also known a Secure FTP or SFTP) for accessing and managing files on remote systems.  Unlike standard File Transfer Protocol (FTP), SFTP encrypts commands and data thus preventing passwords and sensitive data from being transmitted in the clear over a network and eliminating the need for third party encryption tools and services such as PGP.

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 or to arrange for a demonstration contact our Sales & Marketing Department

How can I get more information about EHS?

If you would like to receive additional information please contact our Sales & Marketing Department.