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For a healthcare payer’s provider network, the process to get paid has always been a challenge.  The steps providers take each day, from verifying eligibility and submitting claims, to receiving and reconciling payments, are filled with manual work, paper, errors and delays.  As a result, the fragmented, time-consuming and often stressful process to collect payments is adding a lot of cost pressure on providers.

New healthcare reform mandates also put pressure on providers to find ways to get paid more efficiently.  One of the most prominent changes that practices need to prepare for is that approximately 30 million uninsured Americans will begin to receive healthcare coverage in 2014.  This means that more patients will receive healthcare services, and hundreds of millions of claims will be added to the U.S. healthcare system.  Therefore, the challenges providers face today will only become more difficult.

Threat to the Payer-Provider Relationship

The main issue today in the healthcare payments industry is the provider’s lack of payment assurance – the certainty that one will get paid.  Since the relationship between payers and their providers is based on the promise of payment, the issue of payment assurance is a fundamental threat to the current healthcare system and the payer-provider relationship.

Enhance the Provider Experience

Payers are in a unique position to capitalize on the opportunities presented by the changes and challenges in the industry. While the lack of payment assurance is creating friction between providers and payers, payers can deliver payment assurance tools and strategies to their providers to increase provider network satisfaction and greatly enhance their competitive position in the market.

Here’s how payers can enhance the provider network experience by delivering payment assurance:

Pay Providers Electronically

Solve provider challenges of inefficient payment posting and reconciliation by paying them electronically, via ERA/EFT (electronic remittance advice/electronic funds transfer).  ERA/EFT payments will simplify provider processes as well as reduce payer administrative costs associated with printing and mailing checks and remittances.

[For best practices to pay providers electronically, click here.]

Payment Estimation

Offer providers easy-to-use tools that will enable them to determine member benefit and financial eligibility at the point of service.  This enables providers to more easily communicate payment expectations with members and save member payment information on file to collect automatically once the claim has been adjudicated.

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