Tag: claims

4 Questions to Ask

Question 4: How Does Your EDI Partner Reduce the Burden of Claims Submission for Providers?

Plan members want access to a range of high- quality providers. Without a robust provider network, health plans are challenged to grow membership and differentiate themselves from competitors.

The Council for Affordable Quality Healthcare (CAQH) 2022 Index reported that providers spend ten minutes submitting a single electronic claim on average. For paper, it’s 22 minutes. A large part of this is repetitive data entry. These time blocks add up to significant resource drains in a typical day. Alleviating stressors will reduce payer-provider friction and promote cooperation in your common goal to improve health outcomes for members.

With the right EDI partner, you can streamline operations, reduce administrative burden, and improve your organization’s bottom line. Embracing new technologies and cooperative partnerships can help you gain a competitive advantage and, ultimately, provide better care to members.

Our fourth and final question leads you to ask yourself: “Is my EDI partner providing holistic support to my partner’s and my own organization’s operations?”

How Does Your EDI Partner Reduce the Burden of Claims Submission for Providers?

Plan members want access to a range of high- quality providers. Without a robust provider network, health plans are challenged to grow membership and differentiate themselves from competitors.

The healthcare industry is becoming more consumer-driven and labor shortages continue to mount. Health plans need to be mindful of provider relationships and the administrative burdens your claims processing may be placing on them.

The Council for Affordable Quality Healthcare (CAQH) 2022 Index reported that providers spend ten minutes submitting a single electronic claim on average. For paper, it’s 22 minutes. A large part of this is repetitive data entry. These time blocks add up to significant resource drains in a typical day. Alleviating stressors will reduce payer-provider friction and promote cooperation in your common goal to improve health outcomes for members.

Your healthcare EDI partner should help you to help providers with an affordable billing tool. Our solution, MYUHIN, reduces repetitive data-entry, and solidifies coding and submissions data to satisfy your processing requirements. Providers can use MYUHIN to submit claims, check patient eligibility, and search, view, and download payment information from any computer, any where.

UHIN is a national EDI network built in 1993 by health plans. We partner with payers and providers across the US. Our approach to EDI and customer service is different. If you’re interest in learning more, please contact us today.

---

4 Questions to Ask

Question 3: Are Providers Frequently Contacting You With Questions About Their Claims?

Health plans constantly seek to optimize their high-performing provider networks which provide value to members and patients. To grow these important networks, payers should nurture their provider relationships through personal attention and cutting edge technology.

This is particularly important at a time of mounting staffing shortages and rhetoric of economic downturns. Additionally, medical claim volume increased by 28% in 2022 as vaccines became available, medical offices reopened and pandemic regulations softened. When you add this up, the need for administrative simplification becomes more obvious for health plans and providers.

Tracking down claims, managing denials and submitting myriad claims can burden staff, compound labor costs and decrease profitability. When your provider network is stressed then your ability to grow as a carrier is impacted. Your EDI partner should automate workflows and manage your trading partner network so your support staff can focus on more strategic priorities, rather than answering phone calls and emails all day long.

Our third question addresses this concern as you ask yourself, “how does my EDI partner stack up?”

Are Providers Frequently Contacting You With Questions About Their Claims?

When resources are tied up managing claim inquiries, you’re likely underperforming your peers and weakening your organization.

An inability to provide visibility to track and troubleshoot claims in a timely fashion can create financial implications. The increased demand on staff can decrease productivity, which could further delay payments and lead to staff burnout and turnover. Payers must respond to providers within a regulated timeframe, and providers rely on prompt payment for cashflows and their own business growth. Further dissatisfaction amongst providers and members can upend the collaborative nature of interoperability and could drive providers and members away to different plans.

The volume of inquiries to track down claims can burden staff and compound labor costs through the need to hire additional people. The situation can foster negativity between providers and operators, reducing satisfaction for both groups. Your EDI partner should work with you to increase your ability to automate claims processing. Part of this is facilitating a simple, electronic process for providers to submit their transactions and understand the status along the way.

UHIN is a national EDI network built in 1993 by health plans. We partner with payers and providers across the US. Our approach to EDI and customer service is different. If you’re interest in learning more, please contact us today.

---