payers Blog Posts - Page 2 of 3

Virtual Payments: Not Just a Phase in Healthcare

Virtual payments are an emerging payment method for payers to send payments to providers using the card networks. These payments are more commonly known as “virtual cards,” since the recipient can process them just like a credit card.

Thirty-seven percent of providers indicated that they received virtual payments from some payers.

This statistic accurately demonstrates what many providers are currently experiencing: Virtual payments are increasingly leveraged by payers as an alternative to mailing paper checks. While many believe that virtual payments are

Tagged healthcare payments, patient payments, payer-to-provider payments, payers

Latest Trends and Practices for Payers to Prepare for the Future

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

Tagged best practice, CAQH, consumerism, EFT, ERA, healthcare payments, payers

ERA/EFT Mandate: Impacts to Providers

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

Tagged administrative costs, best practice, CAQH, compliance, EFT, ERA, payers, providers

3 Models to Achieve Compliance with Upcoming Mandates

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

Tagged administrative costs, Affordable Care Act, CAQH, claims, clearinghouse, compliance, CORE, EFT, eligibility, ERA, healthcare payments, healthcare reform, payers, remittance

5 Things You Can Do to Prepare for the January 2013 Mandates

What’s ahead for payers?

On January 1, 2013, payers will be required to meet the first set of mandated operating rules for Eligibility and Claim Status, under the Patient Protection and Affordable Care Act (PPACA). Click here to view the complete set of CAQH CORE Eligibility and Claim Status Operating Rules.

What can payers do to prepare?

1. Focus on Education

Frequently, half the battle of preparing for mandates is gathering all of the information you need. CAQH CORE released an analysis and planning

Tagged Affordable Care Act, CAQH, claims, clearinghouse, compliance, CORE, eligibility, healthcare payments, healthcare reform, payers, private cloud

CAQH Webinar: Prepared for Federally Mandated Operating Rules?

This webinar has already occurred.

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Check back for upcoming webinars in the CAQH and InstaMed Webinar Series!

Don’t miss the latest webinar in the CAQH and InstaMed Webinar Series: Are You Prepared for Federally Mandated Operating Rules? Lessons Learned and Best Practices for Implementation

The deadlines for implementing federally mandated operating rules are fast approaching for payers, providers and vendors. Is your organization prepared?

In this webinar, hosted by CAQH and InstaMed, you will learn:

How payers, providers and vendors can

Tagged CAQH, claims, clearinghouse, compliance, CORE, EFT, eligibility, ERA, healthcare payments, healthcare reform, payers, providers

Going Electronic? How to Get Your Providers on Board

Last year, the majority of surveyed healthcare payers said that less than half of their provider networks did not accept ERA or EFT (read more: 2011 Trends in Healthcare Payments Annual Report). Of the providers who did not accept ERA or EFT during the time of this survey, nearly half said the reason was that they simply preferred paper.

However, according to the HHS interim final rule on EFT standards, payers will need to adopt ERA/EFT by January 1, 2014; and,

Tagged administrative costs, best practice, compliance, EFT, ERA, healthcare payments, healthcare reform, payer-to-provider payments, payers, reconciliation, remittance

Enhance the Provider Experience: Deliver Payment Assurance

In an earlier post, we discussed one of the major threats to the payer-provider relationship: the provider’s lack of payment assurance. This threat poses an opportunity to payers to give their provider networks the tools needed to achieve payment assurance. In our previous post, we gave tips for payers to deliver payment assurance to their providers. Below, we’ve included a graphic of the Payment Assurance Framework to demonstrate how payers can deliver payment assurance to providers in each step of the healthcare

Tagged administrative costs, best practice, claims, clearinghouse, EFT, eligibility, ERA, healthcare payments, patient estimation, patient payments, patient responsibility, payer-to-provider payments, payers, remittance

How to Keep Your Provider Network Happy

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.

Tagged administrative costs, Affordable Care Act, best practice, EFT, eligibility, ERA, healthcare payments, healthcare reform, increase collections, patient estimation, payer-to-provider payments, payers, payment assurance, payment strategies, private cloud, providers, reconciliation, remittance

Hold the Phone! Tips on Reducing Call Center Volume

With new regulatory mandates like the medical loss ratio (MLR) pressuring the healthcare industry to improve efficiency, payers and emerging ACOs are looking at ways to reduce administrative costs. For many organizations, one of the more obvious areas in need for greater efficiency is the call center.

In the last decade, the increase in provider call volume has become a growing concern (see: “Health Insurance Call Volume Increasing”). In fact, according to the 2011 Trends in Healthcare Payments Annual Report, call

Tagged ACO, administrative costs, Affordable Care Act, best practice, claims, compliance, EFT, ERA, healthcare payments, healthcare reform, Medical Loss Ratio, payer-to-provider payments, payers, private cloud, trends

Blog Post Topic: payers