In a multi-vendor scenario, such as one vendor handling paper conversion and another vendor handling EDI intake, inconsistencies between the two vendors can lead to complications and confusion, especially if business rules are being enforced by one vendor but not another.
Claims may be delayed, and unnecessary time may be spent on manual tasks, like scanning documents or physically mailing them to the appropriate destinations. Methods of transferring information between vendors can be less secure, which could put Patient data at risk. Healthcare vendor management can also be time-consuming, resulting in more time spent managing distinct project workflows. Overall, multi-vendor scenarios can slow down claims processing.
On the other hand, if workflows are handled by a single partner, they will apply a consistent process to any intake channel, streamlining workflows. Vendor consolidation can also save time and money, improve automation, and increase security. The result is more accurate, rapid claims processing, which benefits Payers, Providers, and Patients alike.
Examples of processes that can be consolidated to one vendor, such as Smart Data Solutions include the following:
Outsourced Mailroom Services
If your mail intake solution is managed by your exclusive inbound gateway, any necessary line of business identification or customized business rules can be applied at the very first touchpoint for the claims and correspondence. This creates synergy between the EDI intake processes and the data capture solutions. When the mailroom/imaging vendor and the data capture vendor are the same, the handoff from one part of the process to the next is more secure, ensuring Patient data remains confidential. In addition, the imaging process can be customized to create images that are of optimal quality for the data capture processes, improving accuracy downstream. Vendor consolidation can optimize mailroom services to create efficiencies in processing and increase scalability, benefits that ultimately are passed on to the Patient.
OCR & Data Capture
While some data capture providers focus exclusively on claim intake and data capture, service providers who can manage additional custom or proprietary forms greatly enhance inbound document capture processes. Sophisticated front-end capture vendors are also capable of managing enrollment applications, appeals, member submits, and non-standard claim forms, as well as other correspondence and supplemental materials. Along with data capture, Optical Character Recognition (OCR) is often outsourced. Vendor consolidation creates a holistic approach to incoming document management and can go beyond what a less sophisticated solution may offer, such as added automation. At SDS, our approach to OCR and data capture leverages technology and automation, which can reduce front-end challenges and lead to up to 80% cost savings.
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 applies 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 rules and compliance checks prior to adjudication, which can lead to more accurate, rapid claims adjudication downstream.
Medical & Workers’ Comp Claims Management
Worker’s Comp Payers benefit from all of the same enhancements and synergies of vendor consolidation as those Payers in the commercial markets and can also incorporate additional processes such as claim matching. This upfront claim identification approach, when applied to all of the paper intake, EDI intake, and correspondence classification, helps to ensure that all submissions are as pre-processed as possible to streamline all downstream Payer processes that 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 documents route directly to the personnel responsible for processing them automatically.
FSA, HRA & DCA Claim Processing
Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs), or Dependent Care Accounts (DCAs) claims must be verified and documented, which can be a time-consuming and expensive process. A single vendor preparing FSA, HRA, and DCA claims for auto-adjudication can apply consistent business rules to the claims. Standardization can lead to less manual oversight and increased accuracy, allowing the claims to move downstream quicker. Using automation and technology, vendors can use validation checks to conduct pre-adjudication easier, simplifying the workflow and reducing overhead throughout claim processing. In return, Patients can receive their reimbursements faster.
Vendor Consolidation Creates the Same Business Rules Across the Board
Overall, vendor consolidation creates synergies between different processes. This results in faster billing reconciliation and fewer errors throughout processing. Today’s Patients expect instant communication and error-free information. Vendor consolidation for healthcare claims processing helps Payers and Providers meet this high expectation.
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. When you’re considering vendor consolidation, review the services above to determine which initiatives could be moved to one partner.
Smart Data Solutions has 20+ years as an industry leader in healthcare workflow automation. For help transitioning your company into a streamlined, single vendor, contact us today to get started.