Automating Claims Remittance Posting & Payment. Reconciliation for Healthcare Providers

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1 Automating Claims Remittance Posting & Payment Reconciliation for Healthcare Providers

2 Disclosures Gordon Sellers Director, Market Development We are actively partnering with a number of banks, lockbox providers and others to deliver Medical Banking to the healthcare market. In 2011 we processed in excess of 17 million remittances

3 Healthcare Payments Automation

4 Transactions Standards Issues Providers system vendors built their interpretation of the EDI 837 specification Payors systems vendors built their interpretation of EDI 837 Clearinghouses provide EDI 837 transforms to enable process Provider Healthcare Clearinghouse Payor EDI 837 Claim File EDI 837 Claim File EDI 837 Transformation

5 Transactions Standards Issues Providers systems vendors built their interpretation of the EDI 835 specification Payors systems vendors built their interpretation of EDI 835 Clearinghouses provide NO EDI 835 transforms to Providers Provider Healthcare Clearinghouse Payor EDI 835 Claim File EDI 835 Claim File NO EDI 835 Transformation

6 Healthcare Lock Box Processing Considerations Specialized processing in the bank lockbox HIPPA and compliance issues Opening and separating mail into batches Payer / Provider EOB Zero pay EOB (not correspondence) Correspondence 300 DPI imaging Deposit information Checks ACH Integration of patient payments

7 Claim Data

8 Remittance Data

9 Transaction Re-Association & Balancing Re-Associate each patient claim and charge line to a Patient remittance Ensure that all the math on the claim line, for the Patient and for the batch balances Including any batch level adjustments Then reconcile against deposit to Providers deposit account

10 2 Channels = Manual Reconciliation Paper Checks through the Lockbox EFT through the ACH Network Paper EOB Provider Healthcare Clearinghouse Payor EDI 835 Claim File EDI 835 Claim File NO EDI 835 Transformation

11 Streamline Reconciliation Data and Payment flows though Same Channel Paper Checks through the Lockbox EFT through the ACH Network EDI 835 Claim File Paper EOB & EDI 835 File Provider Healthcare Clearinghouse Payor

12 Electronic Funds Transfer in Healthcare Standards Emerge Section 1104(b)(2)(A) of the Patient Protection and Affordable Care Act Adds electronic funds transfers (EFT) to the list of electronic health care transactions that must be adopt as a standard under HIPAA Interim final rule adopted January 1, 2012 with final rule that is to be effective by January 1, NACHA EFT matched to HIPAA 835 transactions This transaction involves Protected Health Information This transaction can be done now no need to wait

13 Key Findings of InfoTrends Reconciliation Study EDI 835 File Green Blue = Payment amount = EFT trace number Orange = Lockbox Account Number

14 BAI2 File Green Blue Reconciliation = Payment amount = EFT trace number Orange = Lockbox Account Number

15 Key Benefits for Providers Single remittance connection for payer-to-provider Greater visibility into their transactions Full 360 degree view of claim, remittance, check, secondary claim and resubmission Reduced administration costs Process automation Transaction matching Increased EDI and single source for claim and research Reduced headcount needed to chase paper Shorter time to cash Processing efficiencies and transaction visibility Integration to bank lockbox processing

16 New Revenue Opportunities Paper conversions Electronic matching Secondary billing Cross sell / Up sell other products Extended Customer Service Leverage existing relationships Solidify lockbox offerings keep or grow share Risk Mitigation Lock box poaching by competition Supports HIPAA compliance requirements Key Benefit for Banks

17 Questions?