Convincing Decision Makers to Adopt a Single Vendor Gateway

Posted by Smart Data Solutions on December 4th, 2019
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Smart Data Solutions

Although the reasons for change may seem apparent to some, oftentimes convincing your board, or other key decision-makers, to adopt new processes or changes can be a challenge. Here are some of the benefits of adopting a single vendor gateway, and some tips on how to convince your team to switch to a more streamlined process.

Why Your Company Should Adopt a Single Vendor Gateway

Consolidating to a single vendor gateway can help save time, money and can also enhance claim pre-adjudication processes. In a multi-vendor scenario,  such as one vendor handling paper conversion and another vendor for EDI intake often times inconsistencies between the two vendors can lead to complications and confusion where business rules are being enforced with one vendor but not another. With a more streamlined single vendor solution, both functions could be handled by the same vendor applying a consistent process to both intake channels.  Streamlining has other benefits as well such as consolidating vendor management, freeing up time managers can spend elsewhere. Examples of processes that can be consolidated to one vendor, like SDS, include the following:

Outsourced Mailroom Services

If your mail intake solution is managed by your exclusive inbound gateway, that allows for any necessary line of business identification or any customized business rules to be applied at the very first touchpoint for the claims and correspondence. This creates synergy not only with the EDI intake processes but also the data capture solutions as well. When the mailroom/imaging vendor and the data capture vendor are one in the same, there is a much more secure handoff from one part of the process to the next.  The imaging process is done such that the images created are of optimal quality for the data capture processes.

OCR & Data Capture

While some data capture providers focus exclusively on claim intake and data capture, service providers who are able to manage additional custom or proprietary forms can greatly enhance your inbound document capture processes. Sophisticated front end capture vendors are also capable of managing enrollment applications, appeals, member submits, non-standard claim forms as well as other correspondence and supplemental materials. This service offering creates a holistic approach to your incoming document management again, not only offering the benefits of vendor consolidation but also going beyond what a less sophisticated single vendor solution may offer. Optical Character Recognition, or OCR, along with data capture is commonly outsourced. Vendors of data capture services get sent paper documents and forms from clinics and providers to their facility for processing and capture.

EDI Clearinghouse

Similar to mailroom and data capture services, clearinghouses can also benefit from consolidation. The streamlined business rule approach applied to the mailroom and capture processes also apply to the EDI clearinghouse gateway.  This allows for additional pre-adjudication checks to ensure that all of your claims are passing through the same business rule and compliance checks prior to adjudication.

Medical & Workers Comp Claims Management

Worker’s Comp payers benefit from all of the same enhancements and synergies as those payers in the commercial markets and can also incorporate additional processes such as claim matching.  This upfront claim identification approach applied to all of the paper intake, EDI intake, and correspondence classification helps to ensure that all submissions are as preprocessed as possible to streamline all downstream payer processes which would follow.  In many cases, further pre-screening checks can be applied such as aligning the claim id with the case managers assigned to each case and having all of the documents route directly to the personnel responsible for processing them automatically.

Consolidating Can Allow you to Apply Same Business Rules Across the Board

Overall, the benefits of adopting a single vendor gateway can be streamlining vendor oversight, applying universal rules, and creating synergies between different processes. Smart Data Solutions provides all of the above services, integrated with additional customization, automation, and machine learning processes, creating a streamlined comprehensive front end gateway solution for our clients.  So when you are considering adopting a single vendor gateway, the details we have laid out offer some of the benefits from this solution.  Here are some additional tips to help gain acceptance from key stakeholders and decision-makers:

Smart Data Solutions can help with vendor consolidation with our multitude of services offered that round off any processes that are utilizing multiple vendors when they don’t have to. We are industry leaders in healthcare workflow automation and if you need help transitioning your company into a streamlined, single vendor gateway, we’re here for you.

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