Despite much progress in the electronification of business processes, the healthcare industry is still faced with a proliferation of disparate technology/processes and a lack of standards. For a typical healthcare provider – who must interact with numerous payers in order to verify patient eligibility, submit claims, receive claim status updates, and accept and interpret adjudicated claim payments and remittance documents – this creates significant inefficiency.
Historically, providers have had to follow several disparate processes across multiple vendors to manage submitting claims to various payers, getting paid and everything in-between. Health plans who are FIS clients report that, with traditional eligibility systems in place, 60 percent of incoming calls are from providers seeking eligibility information and verification. Another 25 percent of calls are related to claim status inquiries from providers. These tasks, including initiating paper check payments and paying for postage, have been traditionally inefficient and expensive ones for payers and providers, thus driving up the cost of healthcare.
Forging new connections between payment and data systems to quicken the claims process, FIS’ HealthGateway enables healthcare providers to expedite benefits eligibility verification and claims submission, accept multiple forms of patient payment, reconcile health plan (payer) payments to claim activity and receive associated explanation of benefit (EOB) and electronic remittance advice (ERA). With connections to more than 1,200 (and growing) payers, HealthGateway delivers all of this functionality through a single, on-demand, online self-service tool. Combined with HealthCollect, FIS’ lockbox solution, HealthGateway delivers faster access to cash receivables, increased operational efficiency and a reduction in administrative overhead for providers.
Increased consumer responsibility for the cost of their healthcare has changed the dynamics of the healthcare industry and heightened providers’ focus on revenue cycle management. HealthGateway helps healthcare providers maximize workflow efficiencies around claims handling and streamline receivables management, quickening the claim-to-cash cycle.