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.

Electronic Remittances:

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 providers.

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 corrections.

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.

Contract Management:

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.

Scanning:

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 expectations.

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

• Promoting e-billing: A win for both customers and carriers, carriers are giving customers discounts for e-billing and paperless statements, while promoting and reaping the cost and environmental benefits of e-billing.

• Facilitating multiple e-payment options: Leading insurers are now taking multiple forms of electronic payment (online, mobile web, mobile app and over the phone), and want to make it as easy as possible for consumers to pay using whatever payment method they prefer, whether debit or credit card, check, or electronic funds transfer (EFT).

• Enhancing customer self-service:Top carriers are providing more billing information directly in the hands of customers through self-service portals, mobile apps, and advanced telephone response systems. They extend assistance via multiple channels, such as phone and web chat, which make support easily accessible from customer billing screens, enabling both consumers and customer service representatives to get straight to any issue that may come up.

• Delivering targeted communications: : Insurance companies at the leading edge are thinking comprehensively about the billing experience – including making the billing process an additional source of revenue. Some insurers include third-party ads in their bills as an additional client benefit (offering related services at discounts) and revenue increase (through referral fees and revenue splits with partners).

• Enabling product innovation: Leading companies are launching new products and services to market faster by using efficient billing systems. Scalable systems are imperative to enable these product and service innovations..          

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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