Dear Physician and Office Staff: Imagine a scenario in which your office staff could adjudicate a claim and know how much to collect from the member at the time of service. Your practice could avoid such familiar frustrations as waiting for the results of claims adjudication, reconciling estimates of the member’s cost with actual costs and issuing refunds. Fantasy? No. The process described, known as real-time claims adjudication (RTCA), is one that Humana is working hard to make a reality — part of our larger commitment to offering cutting-edge technology and services to the health care providers in our network. A few issues ago in Humana’s YourPractice, I mentioned in this space that Humana is at the top of the industry when it comes to paying provider claims fast and accurately. We want to do more to offer provider solutions; now, we have the capability. Here are two ways Humana is working for you: with our claims processing platform and the HumanaAccess card, we have the technology and the tools in place to advance real-time claims adjudication. Humana is currently piloting RTCA, using technology that integrates the clearinghouse, practice management systems and our own systems. Our integrated process avoids manual and duplicative keying steps and works in conjunction with a popular practice management system and clearinghouse to adjudicate a claim within 30 seconds or less at the time of the patient visit. Medical Economics (May 2005 issue) estimates that establishing the necessary connectivity among patients, physicians and payers won’t be in place until 2006, at best. However, Humana is working to make it a reality today. What will make Humana’s RTCA process a complete success is support from providers’ offices and a specific practice management system and work-flow process that are able to submit a claim at the time of a patient visit. With the right tools in place, the claim is adjudicated within 30 seconds, and the patient can pay his/her responsible portion of the claim before he/she ever leaves your office. In addition to our RTCA pilot, we have created a discount program designed to help reduce transaction fee costs for your practice. Humana, in conjunction with Paymentech L.P., is pleased to offer you a new program available exclusively to Humana and Humana ChoiceCare Network participating providers. Paymentech L.P. is a premier provider of electronic payment solutions. Through this new program, your practice can accept credit and debit cards at significantly discounted processing rates. As a benefit of your participating status in Humana’s network or Humana’s ChoiceCare Network of providers, you can convert to Paymentech quickly and start receiving the discounted Humana provider rate. A Paymentech representative can provide you with a free competitive analysis detailing how you can save. Simply fax two months of existing processing statements to Paymentech Sales, Attn: Humana (866) 895-2213. To begin accepting credit and debit cards,
or to simply learn more about the Humana/Paymentech program, please
contact a Paymentech representative directly at (800) 824-4313.
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