Case Study: TPA Reduces Costs by 90% with InstaMed Claims Settlement

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By eliminating paper and postage while consolidating payments with InstaMed’s Claims Settlement solution, the TPA has achieved savings of 90% compared to a paper-based settlement and disbursement process.

- Third-Party Administrator (TPA)

BUSINESS PROBLEM

Prior to working with InstaMed, the Third-Party Administrator (TPA) paid its providers using a paper-based system, which was driving up administrative costs. In addition to sending paper checks and paper remittances to providers, the TPA did not consolidate any payments – for example, they often sent multiple checks and remittances for different employer groups to the same provider. This inefficiency generated higher fees, as the TPA would have to pay for additional printing, paper and postage. On top of these fees, the TPA incurred additional expenses from managing a high volume of return mail as a result of incorrect provider addresses or difficulty delivering paper payments to a P.O. Box.

The TPA received continual requests from its provider network to deliver electronic remittance advice (ERA) and electronic funds transfer (EFT) and recognized the value of switching to an electronic payment system. However, implementing system and file changes with its existing print vendor had been complicated in the past, so the TPA foresaw the conversion from paper to electronic processes as a time-consuming and costly undertaking.

THE SOLUTION

With the InstaMed Claims Settlement solution, the TPA was able to quickly and easily support Integrated ERA/EFT®. Leveraging the InstaMed Network of providers, the TPA quickly connected to many providers electronically, significantly reducing operational costs for settlement and disbursement, and accelerating the speed-to-value realization.

InstaMed met the TPA’s compatibility requirements by supporting a flexible format for file output, which eliminated the need for complicated programming work and made the implementation process inexpensive and quick. With InstaMed, the TPA is able to automatically output remittance and payment data to generate HIPAA-compliant 835s and electronic payments to send to providers, significantly reducing the costs of paper and postage. Furthermore, by delivering Integrated ERA/EFT, the TPA can easily consolidate provider payments coming from multiple employer groups, which reduces the costs of delivering payments, including decreased banking fees. The TPA saw additional savings by decreasing return mail through delivering Integrated ERA/EFT.

The TPA recognized the need to drive provider adoption of Integrated ERA/EFT in order to reduce costs as well as improve provider network satisfaction. InstaMed took on all provider adoption efforts through its turnkey provider adoption program, so the TPA did not need to expend resources to enroll its providers in ERA/EFT. As a result, the TPA has seen a growing provider adoption rate, which has directly impacted its bottom line. For providers that adopt Integrated ERA/EFT, the TPA offers 24/7 online portal access to view their remittance and payment information. By giving providers transparency into this information and by efficiently delivering ERAs and EFTs, the TPA has significantly enhanced its provider network satisfaction.

BUSINESS RESULTS

By eliminating paper and postage while consolidating payments with InstaMed’s Claims Settlement solution, the TPA has achieved savings of 90 percent compared to a paper-based settlement and disbursement process. Moreover, as the TPA expands Integrated ERA/EFT adoption to its out-of-network providers, the payer expects to see a significant reduction in provider call center volume, which will result in greater operational efficiency and cost savings.