Facilitating provider-payer communications frees up resources to improve patient care
Health care providers face increased pressure to focus on quality patient care while simultaneously serving as financial stewards of hospitals and medical practices. The day-to-day administrative demands of interacting with a multitude of payers and their individual portals, a lack of standards and transparency, and a persistent reliance on outdated manual processes continue to strain healthcare practitioners and their staff.
In addition to adding to an already overburdened workforce, administrative tasks are costly. In fact, studies show that the healthcare industry could save $20 billion each year by reducing manual processes and adopting electronic administrative transactions.
Emerging cloud-based technologies are revolutionizing the way providers interact with payersstreamlining communication and collaborations, and optimizing patient care by providing a secure, multi-payer platform that delivers vital administrative and clinical information to providers in real time.
Access to health plans
Providers and staff spend a lot of time every day navigating billing and insurance functions across many health plans. These tasks typically require long phone calls, mountains of paperwork, and searching for hard-to-locate data needed to complete a patient’s chart.
By improving communication between physicians and payers, a network can facilitate payer-provider collaboration and align financial incentives, reduce administrative expenses, and increase the aperture levels. Vendors can have quick access to member and vendor information that is both secure and HIPAA compliant using this platform, saving them time and effort to research this information independently.
Facilitate the exchange of documents
The ongoing exchange of documents, as well as communication between health plans and providers, is an essential part of the high quality healthcare experience. Technology solutions can support this two-way exchange of information to enhance vital clinical workflow by transmitting administrative, financial and clinical information securely and in real time.
Examples of this type of information include fee schedules, risk adjustment information, quality measurement data, and performance reports. Additionally, document exchange allows physicians to manage their patient panels by providing quick and seamless access to clinical information such as patient summaries, high-risk patient lists, and care gap reviews.
Real-time membership verification and coverage information
Efficient collaboration-centric technologies can simplify membership verification and coverage transfer for payers and providers.
On average, 28 eligibility and benefit checks are required per member each year, which can create inefficiencies and logistical bottlenecks if not properly managed. Delivery of care can be expedited using collaborative platforms that provide enrollment verification, benefit coverage information, and patient payment responsibility. The latter includes information on co-payments, deductibles and benefits.
Additionally, these systems can filter and apply specific plan search criteria, as well as set default data values and electronic data interchange parameters aligned with payer and provider requirements.
According to recent research, payers can save approximately $9.8 billion annually by automating workflows to determine eligibility and benefits. This frees up money for use in other crucial aspects of patient care.
Streamlined claims investigation and management
About 168 million phone calls are made annually between providers and health plans to verify the status of claims. Automated claims status investigation workflows eliminate these laborious calls by providing real-time access to detailed financial and claims status information.
Electronic workflows automate the delivery of claim receipt confirmation, award status and payment details, allowing end users to see the status of a claim at any time and view all submissions of clams, regardless of the method of submission. These tools increase provider satisfaction by accepting costly claim exceptions for many entities, from the largest provider firms to independent practitioners, transportation companies and hobby billers. Additionally, they dramatically reduce costs by replacing paper-based claims, expensive clearinghouses, and health plan-subsidized submission software, modifying claims to minimize rejections, and saving an estimate. $3.1 billion annually.
Simplify prior authorizations
Streamlining pre-authorization procedures is another important benefit of using modern payer-provider collaboration technologies. As the complexity of medical regulations, guidelines, and standards continues to grow, this process can become cumbersome for payers, providers, and patients.
Surprisingly, only 26% of authorizations are electronic, meaning the majority of them require tedious phone calls and time-consuming paper claims. Reorganizing these laborious manual processes into a streamlined electronic format with digital patient data dramatically reduces administrative tasks.
With the appropriate digital tools, automatic queries and applications can be made for the exchange of clinical, financial and administrative data in real time. This allows providers to have access to the most up-to-date information regarding medical status, approvals and denials, which in turn enables them to focus more on patient care.
End-to-end electronic collaboration between payers and providers ultimately increases workflow efficiency and provides integrated data resources that are up-to-date, user-friendly and intuitive across the spectrum of health care. health. When communication flows freely and ambiguity is removed, the results are increased efficiency and accuracy for the benefit of the patient.