Going Electronic: The Optimization Blueprint for Claim Payments

Amid the surge of digital transformation occurring across healthcare, payers and providers are increasingly rethinking the way payments are traditionally submitted, processed, and received.

Outdated, paper-based processes introduce myriad challenges for these organizations today, but through strategic payment optimization and the right technology, there is massive opportunity to reduce financial and procedural inefficiencies, drive savings and simplicity and solve some of the biggest reimbursement pain points.

In addition to the pandemic pushing the prioritization of digitally-enabled operational optimization, and as many still struggle to overcome the past year of financial strain, the No Surprises Act (NSA) has also added pressure. Providers and payers are scrambling to adjust systems and processes to meet NSA requirements starting next year. The new processes outlined under the law put significant administrative burden on payers and providers alike, driving many to identify areas of their business where operations can be streamlined to reduce the amount of time and resources spent on manual tasks wherever possible, including payments.

By enabling a more efficient, integrated process, electronic payment solutions are optimizing payment processes for payers and providers at a time when reliable, accurate and timely payments are of utmost importance to healthcare organizations. Moreover, member satisfaction and financial experience are improved as payments made on their behalf or by them are accurate and faster.

Driving payer savings

For payers, transforming manual methods to e-payments introduces numerous benefits including the overall cost to pay claims is reduced, payments occur faster thus reducing provider complaints, providers’ ability to drive any additional receivables from the patient is accelerated, and most importantly, e-payments enables a high degree of frictionless transactions due to the growing demand and complexity of data requirements from providers.

Whatever a payer’s focus may be, from in-network dental claims to out-of-network workers’ compensation claim payments, implementing a real-time, integrated electronic payment solution can drastically reduce the cost of making payments while increasing provider and member satisfaction. The number of payers experiencing the benefits of going digital is only growing, and quickly. Based on results of 700 U.S. health plans that have transitioned to integrated, e-payment solutions, payers are saving an average of 60% of the cost of making healthcare payments by cutting avoidable, associated costs of paper-based payments like printing and postage.

Integration and alignment between payers and providers are key to simplifying processes and reducing healthcare spending. Point solutions that treat segmented or siloed parts of payment processes aren’t enough to drive significant, sustainable savings. To achieve savings goals, payers must adopt a fully integrated platform that adds efficiency from beginning to end — managing claim costs, optimizing payments, and enhancing communication with the provider.

Boosting efficiency

Optimizing payments and claims is at the top of the priority list for providers and can be achieved by transitioning time-consuming paper-based processes to electronic payments. Streamlining operations electronically eliminates complexities from the process, helping to reduce costs and boost efficiency. Perhaps most importantly, digital processes allow providers to choose how they want to get paid, and accelerate time-to-payment from slow, manual methods. By transmitting electronically, providers improve practice cash flow, getting paid weeks sooner than they would have waiting on mailed checks. This time savings also enables staff to focus on higher priority operational areas.

Of course, the topic of security must be addressed in today’s digital landscape. Protecting payments data in a secure provider portal is key and vetting a solution’s proven track record in this area can’t be overlooked during a digital transformation. Luckily, there are industry frameworks to aid in this vetting process. Information security certifications from organizations like HITRUST, for example, ensure payment solutions have met key regulations and industry-defined requirements for risk management and data protection. Providers should always check this box when comparing electronic payment platforms.

Embracing digital transformation

While digital transformation of payments gains momentum in the healthcare industry, there is still much ground to cover to achieve a higher functioning, cost-efficient healthcare system. Today, hundreds of billions of dollars still exists in paper check payments across providers and according to the CAQH Index, as of 2020, provider adoption of electronic payments reached 74%.

With the financial implications of the pandemic still looming and as new legislation like the NSA requires payers and providers to adopt and adjust to unfamiliar and complex operational processes, there’s never been more reason to embrace digital transformation and create an efficient, integrated payment ecosystem in healthcare. This is the path forward to making a meaningful impact on avoidable healthcare spending.

Yusuf Qasim is president of payments at Zelis, a healthcare payments and revenue cycle company headquartered in Bedminster, New Jersey.