Technology has revolutionized the world of group benefits, and there are some key areas where efficiencies can be realized to improve the bottom line of your business.
Claims Adjudication
The market demand for real-time claims processing is on the rise, especially for non-drug health claims. This functionality allows plan members to instantly settle their financial obligations to the service provider at the time of care and gives plan members visibility into their providers’ technological innovations. It also gives plan members and service providers a fast, secure and trackable method for settling claims.
Another emerging trend in this space is enabling plan administrators to input and manage plan designs in detail so that adjudication systems approve, deny or report inconsistencies on claims based on the employer’s specifications. Automating this process reduces the margin of error, shortens the settlement time for claims and instantly notifies key members of the claims team when inconsistencies arise.
Cost
Providing secure online access to plan members’ accounts is becoming an increasingly popular way for members to stay in the know. With would-be callers now going directly to the provider’s website—thanks to email communication or call centre redirection—plan providers and customer service representatives can spend their time more productively.
This efficiency ultimately represents savings to the plan sponsor. However, there is still room for improvement for Canadian providers in this area. As younger, more tech-savvy employees continue to enter the industry, we expect to see Web portal usage rates increase to match the adoption rates in other business areas.
Collaboration
A variety of practitioners now have easier access to information and quicker confirmation of payment, allowing multiple parties to collaborate on claims and systems. Dental and pharmacy services are no longer the only healthcare providers submitting online claims. With electronic claim submissions doubling in the past few years, paramedical, chiropractic and vision care service providers, to name a few, can also take advantage of this technology. The introduction of Web portals as part of the e-claims submission allows smaller vendors to electronically submit their claims without the cost barrier of purchasing or setting up their own electronic submission systems.
This is still an up-and-coming trend. Few plan administrators have this capability, and those that do aren’t yet using it to its maximum capacity. For example, one of the top three insurance companies in Canada recently introduced online submission for chiropractic and vision claims, yet it is currently processing less than 35% of claims electronically.
Communication
According to a recent J.D. Power study on insurance providers, information and communication ranked as the third most important factor in plan member satisfaction, yet health plans received low satisfaction scores in this area. With more plan sponsors embracing social media outlets such as Twitter and Facebook to communicate general information to plan members—for example, employers setting up interest groups or advisors tweeting about blogs—an entirely new conversation is starting, and it’s getting plan members more engaged.
Maintaining a proper balance between profitability and simplicity isn’t always easy, but it is vital to a provider’s success. Technology can be a boon to the delivery of a group benefits plan if diligence is taken to ensure that it fulfills the interests of every stakeholder group with a vested interest in the plan’s overall success. From streamlining payments to increased staff productivity, employers and administrators can realize greater efficiencies and economies with the proper technology in place.
John Jackson is president of Automated Benefits Inc.
jjackson@adjudicare.com
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© Copyright 2009 Rogers Publishing Ltd. This article first appeared in the December 2009 edition of BENEFITS CANADA magazine.