Health care providers are increasingly concerned about the impact consumer-directed health care plans and high-deductible health plans have on their ability to collect timely payment from their patients. These plans require patients to pay more out-of-pocket costs, but attempts to collect estimated payments at the time of service may create credit balances or patient dissatisfaction. Providers believe it will get increasingly difficult to collect payments from patients.
How does real-time adjudication (RTA) help?
RTA enables a provider to bill for service before the patient leaves the office and to receive a fully adjudicated response from the health plan at the time of service. With this technology, a provider can print out the response, displaying total and allowable charges, as well as the patient's responsibility. Providers can be certain of the amount the patient should pay.
Humana and RTA
Humana can adjudicate claims in real time for some of its health plans. Members on these plans have been assigned unique member identifiers (UMIDs) that consist of nine digits followed by a two-digit suffix. The UMID for these members usually begins with zeros (example: 000123456-01). The member's UMID is displayed on the member's Humana ID card. Claims that are adjudicated in real time are still subject to post-adjudication review and corrections.
This technology is advantageous to all parties involved in the health care industry, especially providers concerned about the potential for bad debt. RTA reduces administrative hassles by avoiding the need to estimate claims payment. Unfortunately, most provider offices are not quite ready to handle this new technology.
Why aren't providers ready?
Health care providers can submit real-time professional claims to Humana via Availity.com, but they have to manually key them into an entry screen. Most providers are unwilling to perform this duplicate keying. Additionally, many providers are unable to take advantage of RTA for other reasons:
- Many providers are not able to have claims ready for submission to the health plan for at least two days after services are rendered.
- Many providers' practice management systems are unable to submit claims in real time.
- Most clearinghouses are unable to transmit provider claims in real time.
What is Humana's solution to the dilemma?
The Humana solution is to create interoperability between provider, practice management vendor, clearinghouse and payer. Humana has been working with a number of practice management systems and clearinghouses, including Athena and Availity, to create "real-time" connectivity. Through these partnerships, Humana has successfully developed an integrated real-time claim adjudication solution. To learn more about this capability or to determine if your practice is a candidate for this technology, please send an email to deployment@Humana.com.
Health care providers who are unable to support real-time adjudication in their current workflow can instead utilize Humana's benefit estimator tool. The benefit estimator is a secure Web tool that enables health care providers to create an estimate of a patient's payment responsibility specific to the provider and treatment/service, based on a real-time snapshot of the patient's benefits. To learn more about this technology, please send an email to deployment@Humana.com