Humana Electronic Tools Designed to Heal the Claims Process
The American Medical Association's (AMA) Heal the Claims Process™ month is this November. This campaign calls for physicians and all participants in the health care claims process to streamline their administrative processes in order to help eliminate administrative waste. By improving administrative efficiency, a physician will reduce costs in his or her practice, improve the overall patient experience and increase time and resources that can be devoted to patient care.
Humana has joined other organizations in pledging support for the campaign and to do its part to eliminate waste from the claims process. For Humana, the Heal the Claims Process campaign involves more than just "healing the claim." It includes streamlining the whole administrative process to decrease time spent on paperwork and phone calls and to make getting accurate and timely information easy. Electronic administrative tools are a key component in this effort.
Inefficient administrative processes, such as manual and/or paper transactions, result in an estimated waste of $30 billion a year. It can cost health care providers more than $3 per manual/paper transaction considering the time needed to verify eligibility, check claims status or submit a referral or authorization.
Using electronic tools can eliminate many claims issues resulting from inefficiencies in other parts of the health care process. For example:
- Many times, claims are pended or are unable to be accepted because the patient's information is inaccurate. By using electronic tools, a physician can verify a patient's eligibility and benefit status prior to an office visit. This allows the health care provider to learn whether the patient has coverage and confirm that the most current and accurate information is entered in the office's billing system prior to submitting the claim.
- Claims are often pended or are unable to be accepted because no referral or authorization is on file. If a referral or authorization is necessary, health care providers can both submit the request and check the approval status electronically.
- Health care providers can save time that would be spent on the phone with customer service by accessing claims status information electronically.
- Claims payments may be delayed when claims are submitted by mail or when a health care provider chooses to receive payments by mail. Not only can health care providers submit claims electronically, but receiving payments electronically saves money. Electronic funds transfer eliminates printing and mailing costs, as well as the manual effort of opening, copying and depositing checks.
Humana supports many types of electronic transactions. Providers can register on Humana.com and/or Availity.com for online access to health care information. In addition to these Web tools, many practice management systems are able to deliver eligibility and benefits information, claims status and can submit referral and authorizations. Health care providers who would like to streamline their processes through this type of integration should call their vendor for more information.
To discuss any of Humana's electronic resources, health care providers can contact their Humana e-Business consultant, or call Humana deployment at 1-877-260-7360.
