Your Goal is to Make Substantiation Faster and Easier
When brokers bring you into a new relationship with an employer or employer group, all of those parties have a shared expectation: that you as a TPA are going to manage plan participants’ medical claims and needs efficiently and quickly. This is expected regardless of the size of their organization — whether they’re a small company with 25 employees, a mid-market company with 500 employees, or an enterprise with 5,000 employees nationwide.
And while you might think that your team has the capacity and efficiency to manage the claims from those employees, the manner in which those claims are processed will reveal the truth. Unfortunately, far too many TPAs are still processing EOBs in extremely outdated ways. This includes emailing scanned (and often unparsable) PDFs and gathering and distributing harvested documentation via fax machines. These tasks don’t sound time-consuming (How long could it take to write and send an email, right?), but in reality, each of those tasks — whether 15 seconds or one minute — add up to an astonishing amount of wasted time and money.
This is why an automated customer experience is so important — not only for your team but for the participants and their families that need you to work efficiently. Remember that people might not fully understand what an EOB is, what it means, and so on. While they receive them directly, they could also misplace or accidentally dispose of the EOB in the time between receiving it and your TPA contacting them to substantiate. And if you’re manually harvesting and processing EOBs, you’re essentially interrupting their day to go find the EOB and get it to you.
Consider a Claims Self-Service Solution
Claims self-service as part of an automated solution to make this important part of healthcare reimbursement easier for everyone — including your team. Through claims-self service, employees and other plan participants can do a number of things. They can gather their EOBs and submit them electronically to you, thereby centralizing everything and eliminating the need for numerous emails or faxes. Or, they can seamlessly connect their insurance carrier account with your benefits administration platform to allow integration solutions like TPA Stream to automatically search for, gather, and save EOBs found.
As a TPA, it’s to your advantage to make claims as easy as possible for plan participants to navigate. Remember that you have three specific audiences: plan participants, employers, and brokers. It’s important for everyone in your organization to understand this so they realize the importance of their roles for each audience. The majority of your work goes to support plan participants. By keeping them happy, employers remain free from concerns and questions, and brokers don’t hear from employers about any problems.
Once Established, Claims Self-Service Itself Becomes a Product
When your organization has successfully implemented a claims self-service solution, it’s to your advantage to use it as part of a package offering for new employer groups. This makes your organization more competitive in new opportunities and also helps your broker better sell your services to new employers. Not only do you make it easier for participants to get their EOBs submitted and claims substantiated, but you also make the rollout process faster.
This means you’ll be able to get up and running faster, thereby eliminating hassle and freeing up time for employer HR and benefits teams to focus their attention elsewhere. This creates an immediate satisfaction in your customer base. The ramp-up time is vastly lower, their participants are getting their claims substantiated and reimbursed faster, and everything is proceeding just as you and your broker partner promised.
Claims Self-Service Opens Doors for More Benefits
A claims self-service solution also creates an opportunity for participants to take advantage of third-party benefits. When employers are exploring options for their employees, they want to be certain that a) employees will utilize them and b) any processes or workflow involved with them will be handled efficiently. Participants can enjoy an easier experience navigating the claims process, reducing the friction or hesitation involved with them signing up for other benefit options.
This holds value with employers as well, who want to provide meaningful benefit programs and options for employees while also understanding utilization. As an automated solution, claims self-service solutions like TPA Stream provide employers and brokers with important data on what employees are using and what they aren’t. If employees aren’t using their benefits as much as expected, this could mean the benefits aren’t good enough and another solution is needed. If they are, perhaps additional third-party solutions would be worth adding.
Needless to say, there is a significant strategic benefit in implementing claims self-service within your offerings to employers and their employees. But remember, it must be part of a strong workflow. If needed, analyze, audit, and optimize your existing workflows to ensure the way you’re processing claims now works well and doesn’t cause any issues. Through automation, you’ll be able to make that process faster and more profitable for your business — but only if the workflow is built and implemented properly.
Let TPA Stream Support Your Long-Term Strategy
Our integration platform provides a claims self-service solution that makes it easy for participants to provide access to their insurance carrier and automate as much of the claims process as possible. For employers, our solution is white-labeled, promoting their company as the champion of the solution.