Removing the pain of
billing complexity via Insurance Billing System
The premium billing process has traditionally been a large
pain point of the carriers. With modern technology, however, we can solve the pains
of overall customer satisfaction, operating efficiency and supporting customers
via multiple channels.
In an aggressively competitive marketplace, street-smart
insurance carriers embrace consumer friendliness as the primary focus. Engaging
those customers is a challenge in the age of Facebook and mobile. While some of
the focus is on the “sexiness” of the user interface, if the regular billing
process isn’t reliable, the best customer service in the world can only fix so
many complaints about incorrect billing. An all-around efficient and reliable billing
system comes to the rescue, and yet can be quite tricky to implement. Consumers
whose customer service expectations are not met can switch their carrier more
easily than ever – making the dangers of old or fragile billing systems and
integration points that much more dangerous than ever.
Although most people think of a billing software as
primarily used for billing health insurance claims, the billing process of the
insurance coverage itself is actually the first step in the end-to-end
experience of a health insurance consumer. A billing system should be a bundle
of the following integrated features.
To facilitate 820 & 834 EDI remittance files to be
attached with insurance payments, adjustments, and terminations. It’s
important to note here that in the healthcare domain, the 820 is similar to the
EDI 834 transaction set. The 820 caters specifically for plan sponsors – that
is, carriers facilitating healthcare benefits to their employees – to send
information on insurance premium payments to the health plans. The 834 is used
by the health plans for broadcasting information on payments to healthcare service
Collection Agency Interface:
Insurance coverage can be difficult to understand,
even for well-informed customers and for that matter, doctors, hospitals and
pharmacies. It is quite common that insurance bills go unpaid simply due to
confusion about what is truly owed. Understanding deductibles, subsidies, and
other factors, if an overdue bill lands in the hands of third party collection
bureaus, they will need an accurate view into the past and current history of
bills and payments as well.
Pre-Billing Claim Checks:
Pre-billing claim checks are necessary in order to
establish that claims contain all required information prior to submission to
the beneficiary. This flags accounts that may be missing important information
related to certain beneficiaries allowing staff to make proper
Claim Scrubber Edits:
It is essential that a modern Billing System has a built-in
claim scrubber to authenticate “Correct Coding Initiatives” and the “health
care requirement” for the claim that ties legitimate coverage requests to the
services that are covered by the insurance.
Allows carriers to evaluate expected reimbursement
against actual reimbursement for payment audit. Knowing whether claims are
being paid according to contract can prevent lost revenue. Finding any
disconnects as early as possible speeds up the revenue lifecycle for the
carrier, reducing their liability and improving cash flow.
Allows customers and staff servicing customers
throughout their experience to see current and past insurance cards and other
billing information for the customer, enabling staff in different locations
access to the same information.
The above features constitute an indispensable part of
a modern billing system, and are in constant need of strategic upgrade. Often,
core billing systems like these are not modernized more often than every
decade, which threatens the ability of carriers to keep pace with customer
In our research and discussions with insurance
carriers, we have learned that only the leading carriers have modernized their
systems as described above. As a result, they are able to improve operations
and substantially reduce cost while maintaining quality, differentiate services
and improve their working capital structure. Other carriers need to follow suit
accordingly to avoid being outgunned and out run in an ever increasingly competitive,
slim margin marketplace.
STRATEGIC UPGRADE OBJECTIVES
OF BILLING SYSTEM
Is your billing system modern, scalable, and built to
serve your customers, your business, and the needs of the next decade?
PS:-Gunaatita Technology is a pioneer in the field of providing custom billing system catering to Insurance, Banking, Finance, Telecom, Healthcare, Manufacturing & Services domain.
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