In 2014, all payers were federally mandated to support electronic funds transfer (EFT) and electronic remittance advice (ERA) in accordance with the requirements specified in the CAQH CORE Operating Rules. Though the mandate went into effect in January 2014, the industry has been slow to adopt the electronic alternative to paper checks. Many organizations send a high dollar volume through ERA/EFT, but it’s the low percentage of transactions sent through ERA/EFT that keeps print and mail costs high. The costs
The promise of direct-to-consumer solutions – think: wellness incentive programs – is great. Most operate under the theory that members who are actively engaged in maintaining their health will be invested in achieving better health outcomes leading to fewer doctor visits and ultimately to lower costs. This study thoroughly debunked that theory, finding that wellness programs had zero return on investment. (The study specifically examined wellness programs in the workplace, but the results are so clear that they can and
Geisinger Health Plan (GHP) needed a change when it came to their provider payments. The old process to send electronic payments was time-consuming and expensive – yet, two-thirds of their provider network still received paper checks.
GHP chose to partner with InstaMed to bring about some much needed change. With InstaMed, GHP now delivers 85% of provider payment transactions via ERA/EFT and increased annual revenue by $642k. How did they do it? View the infographic below, then read the case study
It sounds like a great achievement – 80 percent of dollar volume sent as ERA/EFT to providers! You’re only 20 percent away from full ERA/EFT adoption, right? Not quite. Some in the industry would have you believe they have achieved huge milestones when it comes to ERA/EFT adoption, but usually the achievements are quantified in dollar volume. ERA/EFT adoption is still low, as 88 percent of providers report receiving paper payments from one or more of their payers. So while
The Trends in Healthcare Payments Sixth Annual Report: 2015 is now available to download – free of charge. For the last six years, InstaMed has released this report to objectively educate the market and promote awareness, change and greater efficiency through quantitative data from the InstaMed Network and qualitative data from healthcare providers, payers and consumers surveyed nationwide.
Click here to download the report.
A previous post detailed the latest trends in healthcare payments impacting how providers do business and best practices for providers to meet those challenges. However, the latest trends in healthcare payments present unique challenges for payers, which they must adequately prepare for – or risk consumer dissatisfaction and lost revenue.
Data from the 2013 Trends in Healthcare Payments Annual Report demonstrates that healthcare payments industry is evolving and outlines how payers can manage these changes. In particular, healthcare consumerism and provider
In 2014, all payers will be federally mandated to support electronic funds transfer (EFT) and electronic remittance advice (ERA) in accordance with the requirements specified in the CAQH CORE Operating Rules. Providers may be wondering how this mandate will affect payer payments and what you must do to be compliant.
Under the mandate, providers have no obligation to accept ERA/EFT from payers. However, the mandate enables providers to improve efficiency and reduce administrative costs. Read on to learn more about how
On January 1, 2014, all payers will be required to support electronic funds transfer (EFT) and electronic remittance advice (ERA). When evaluating how to achieve ERA/EFT, one of the first decisions a payer will need to make is to “build or buy” – whether to use internal resources to build ERA/EFT capability or to work with a third-party vendor.
Regardless of which model a payer follows to achieve ERA/EFT, there are several key considerations that need to be included in the
Recently, we posted a list of five things that payers can do now to prepare for upcoming reform mandates (click here to read the post). This post emphasizes the importance of collaborating with other organizations like clearinghouses, trading partners and vendors, in order to achieve compliance with the mandated CAQH CORE Operating Rules. These relationships are crucial regardless of the approach payers take to achieve compliance.
Below is an outline of the three main models payers can use to meet the
What Are Operating Rules?
Under the Patient Protection and Affordable Care Act (PPACA), the Operating Rules (developed by CAQH CORE) define the guidelines and standards for making electronic healthcare transactions more predictable and consistent, so the industry can be more efficient.
Upcoming mandated Operating Rules include:
Eligibility and Claim Status: Phases I and II
Deadline for payer compliance: January 1, 2013
Why providers should care:
With mandated standards for electronic eligibility transactions, it will be easier for providers to connect to payers to verify patient eligibility