Digital billing. Automated reconciliation. Electronic payments. In some industries, these are already the norm. Banks have adopted electronic payments in a big way for capital markets trades and settlements. Some of the same fundamental approaches can be used in benefits billing, with much smaller investments.
Over the next few years, the digital evolution will sweep through the administration of healthcare insurance, employee voluntary benefits, and worksite benefits. The switchover from manual processing to electronic is timely. As plan designs and contracting rules become increasingly complex, billing needs to be run on an efficient and automated platform.
Despite the advances in automated systems, spreadsheets and paper-based invoicing still dominate the billing methods across industries in the U.S. It is estimated that less than one-third of all invoices are processed electronically. Telecommunications and retail billing, which are heavily consumer-based, are still refining their billing models.
More complex rules challenge group-based environments, such as healthcare, employee benefits, insurance, and the public sector billing. E-Invoicing alone cannot meet the requirements.
To meet the integration requirements of employers and SLAs, a healthcare and benefits billing platform must possess the following crucial core features:
- Be rules-based
- Reside in the Cloud
- Enable automation and AI
- Ingest data from both batch (EDI, XML) and API for real time updates
As plans further diversify, ideally the solutions for employers and coverages for insurance, billing, and payments should not require extensive customization to meet time-to-market requirements. Those that adopt digitally simplified billing, automated reconciliation, and electronic payments will find themselves way ahead of their competitors and peers.
In 2020, four trends are set to disrupt the healthcare insurance and benefits industry, with early adopters gaining “first mover” advantage.
Trend 1: Automation will drive optimization
Automation is the foundation of simplified billing. It has created a new age centered on the ability to:
1) ingest files with different formats for enrollment, invoices, benefit administration and claims, and
2) automate processing based on a rules-based architecture.
Automation extends to notification for case management or to trigger an action, create an adjustment, or perform data-intensive reconciliation for list bills. Bills can be automatically generated electronically, and funds can be automatically pulled from designated accounts.
By automating these manual responsibilities, staff can be redeployed to address exceptions and focus on revenue-generating and other high-value service activities.
Trend 2: Industry requirements will drive SaaS adoption and a highly secured cloud
Software as a Service (SaaS) is the new standard for automated solutions. The users of the system are often remote and need to be accessible by any device—desktop, tablet or mobile—for transaction processing, service, and analytics. By automating payments, the needs of all entities are supported as they work towards providing exceptional customer service for clients and partners.
- Integrates data from disparate sources including batch and real-time
- Enables high availability and access
- Securely stores financial and sensitive data
- Generates analytics required for the various users, sponsors, and regulatory entities involved in billing and payments
A rules-based architecture SaaS platform operating in a scalable cloud environment, with a strong analytics engine, can achieve significant operational improvement. Over time, technologies such as digital wallets, blockchain, and AI can become part of the solution architecture, for additional levels of optimization.
Trend 3: Emphasis will shift toward real-time processing
In today’s environment, volumes of spreadsheets and batch orientation still dominate the back office of many insurance carriers, brokers, TPAs, and billing-related service providers. It is routinely expected that adjustments will be made that go back months to resolve timing issues or human error.
The industry is seeing increased emphasis on API integration from enrollment, benefits administration, claims, HCM, and ERP applications to keep systems accurate on a timely basis. This will extend to billing and payments.
Other improvements are also on the near horizon:
- Real-time additions, update, and termination transactions will improve data accuracy.
- Digital transformation, automation, and simplified billing will increase the speed and accuracy of processing.
- Leveraging auto-pull, B2B electronic payments will occur more frequently in real-time.
- Users will be able to see all transaction details to verify or QA information, address errors flagged by the system, and issue payments per the terms of the plan.
Trend 4: Those that move first will achieve best-in-class advantage
Simplifying billing, automating reconciliation, and accepting electronic payments enable insurance carriers, brokers, TPAs, consultants, associations, captives, employers, and self-insureds to achieve significant improvements, including the ability to:
- Reduce operational costs
- Diversify healthcare and voluntary benefits in a timely fashion
- Improve customer retention where customer plan complexity exceeds current platform capabilities.
- Redeploy staff to revenue-generating or higher value processing activities.
Given the stickiness of billing and its impact on quality, data integrity, and service, “first movers” are best positioned to enhance their brands—and ensure the coverages offered to their employees are being processed by “best-in-class” providers.
Simplified billing is now
AdminaHealth enables insurance carriers, brokers, TPAs, consultants, associations, captives, and employers to capitalize on all four trends in the new year and raise the bar. The AdminaHealth Billing Suite® SaaS platform can replace or extend your capabilities with limited disruption to your current operation.
Our platform accepts feeds from EDI, XML, API, or custom formats, automates the consolidation and reconciliation function, and generates payments to each provider. In scenarios where there are multiple carriers offering healthcare, voluntary insurance benefits, and other coverages, we can issue one consolidated bill and one corresponding outgoing payment from the group that is then split up in transit paying each individual provider. We can also allocate costs back to any hierarchy (department, division, association or captive member, etc.) based on unique needs—no matter the complexity of the employer plan design, captive, association, or broker.
With our flexible structure, AdminaHealth can integrate as a direct partner to your organization or partner in a “white label” model where your brand is maintained as the TPA, insurance carrier, benefit administrator, or outsourcing firm. And it can all be done within a few weeks.
As you plan for 2020, talk to us about how AdminaHealth can help you gain billing efficiencies and minimize costs. We invite you to demo our Billing Suite SaaS Platform to clearly see the transformative benefits of a comprehensive automated solution. To schedule a demonstration, contact [email protected] and for more information visit adminahealth.com or email [email protected].
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About the Author:
Frank Bianchi is the Chief Sales and Marketing Officer at AdminaHealth. He is responsible for leading and growing the Sales and Marketing team, overseeing marketing strategy, and establishing and maintaining relationships and partnerships with key stakeholders. Frank brings over 20 years of experience in the insurance benefits industry, where he has had a track record of implementing digital transformation, platform modernization, process automation, and competitive differentiation.