BJACKSONVILLE, FL – Hoping to duplicate success with its two Georgia plans, a national carrier is implementing its automated payment process system for its Ohio plans.
The national provider of government-sponsored health plans has seen its Georgia payers achieve “significant electronic settlement of claims,” said Lynn Carroll, executive vice president and general manager of Payformance Health.
The carrier did not want to be identified because of the risk of losing its competitive advantage, Payformance Health executives said.
One of the payers is settling more than 50 percent of its claims electronically less than seven months after starting.
The Georgia payers wanted to provide electronic fund transfer with an associated online member roster for their capitated providers. Many state Medicaid programs require that payers put their remittance, or online presentment of data, online.
With the implementation of Payformance Health’s PaySpan Health, the payers were able to offer EFT and electronic remittance advice to all providers.
Payers can save as much as 42 cents per claim by offering EFT and ERA to their provider communities, Carroll said.
David Petsch, owner and president of Augusta, Ga.-based Petsch Respiratory Services, a home health agency, took advantage of the offer to submit claims electronically by the private contractors that bought out the state Medicaid program.
Since the implementation of the EFT-ERA application, the agency has seen an increase in data control and staff efficiency and satisfaction and a reduction in human resource and paper costs.
“If [payers] are going to reduce our fees or increase the cost of administering services, we have to counter and start asking for things that will help us,” Petsch said.
A recent Datamonitor survey indicated that 40 percent of healthcare providers want an electronic health record system that integrates their financial payment systems, underscoring the importance of EFTs.