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Bob Hough, Director of Operations at Geisinger Health Plan (GHP) authored a feature article in the HFMA publication HFM on the transformation of the health plan’s provider payment process by transitioning to electronic insurer-to-provider payments with InstaMed. In the article, Hough describes how GHP streamlined the provider payment process to achieve three key objectives: eliminate a disconnected payment process, increase provider adoption of ERA/EFT and eliminate inefficiency in the payment process.

Read the full article, Overcoming Common Obstacles of Transitioning to Electronic Insurer-to-Provider Payments, in HFM. Below is an excerpt from the article.

GHP became increasingly concerned with the significant challenges associated with paper checks and EOPs. According to industry averages, each manual claim payment costs $3.46 and each manual claim remittance advice costs $6.19, compared with $0.78 and $1.00 respectively for each of those transactions to be sent electronically. These numbers roughly match the amounts GHP experienced.

The costs alone were enough to motivate GHP to reduce paper transactions. But GHP also was contending with other problems in its payment process that prompted it to make a wholesale change. In July 2015, GHP opted to work with a payments network to streamline and consolidate the provider payment process, which allowed GHP to achieve three key objectives.

Eliminate a disconnected payment process. All forms of payment in health care were supported by the payments network. In moving to one source for all payment data and transactions, GHP streamlined a complex IT management structure and eliminated excess costs and administrative effort.

Increase provider adoption of ERA/EFT. GHP was able to connect with providers already receiving ERA/EFT transactions on the payments network, allowing GHP to achieve 60 percent provider adoption instantly. GHP also leveraged a customized, multi-touch provider adoption plan to increase provider education and adoption of electronic transactions. GHP further announced that providers who did not register for ERA/EFT by a certain date would no longer have the option of receiving GHP payments by paper check.

Eliminate inefficiency. GHP eliminated the inefficiencies associated with paper processes by handling all payment process elements and all compliance efforts on one platform. This move reduced payment errors and relieved provider confusion by enabling GHP providers to reconcile every payment received from GHP. The ERA/EFT transaction contains the payment transaction and the remittance transaction simultaneously generated and reconciled at the point of origination on the payments network. The ERA/EFT transaction also includes the TRN Re-association Trace Number, in accordance with CAQH CORE Phase III Operating Rules. Today, GHP delivers 98 percent of all dollar volume and 91 percent of all transactions for provider payments via ERA/EFT.


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