3 Ways to Reduce Provider Abrasion with your Payment Integrity Solution

Provider abrasion is an ongoing challenge for health plans, resulting in damaged trust, increased workloads, and unhappy providers. The problem usually arises from claim denials, payment delays, and cumbersome administrative processes. These obstacles not only lead to provider abrasion, but also significant financial losses, with improper payments accounting for $200 billion in waste spending in 2023 alone.

Health plans can reduce provider abrasion by adopting a payment integrity solution that uses modern technologies to improve payment accuracy and efficiency.

Factors That Lead to Provider Abrasion

In a recent Payer survey from HealthEdge®, “provider relations” followed closely behind “member satisfaction” in a list of health plan leaders’ top business concerns. These relationships are becoming increasingly important as payers and providers are expected to collaborate to achieve industry-wide goals such as reducing healthcare costs, improving clinical outcomes, and establishing effective value-based-care arrangements.

According to payers, inadequate access to real-time information and data sharing is the key contributor to provider abrasion. This is closely followed by inaccurate and delayed payments, and lack of transparency.

There are various reasons for these frustrations. When providers do not have access to updated information, they are unable to check the status of their claims or current reimbursement data. This lack of transparency can leave providers feeling confused or frustrated due to an unclear and complicated claims process. Additionally, payment delays or inaccuracies can leave providers facing potential financial stress, which can damage their reputation. Plus, the administrative burden of the time-consuming claim resubmissions and appeals process often leads to operational inefficiencies for both payers and providers.

So, how can your health plan ensure accurate, timely, and comprehensive claim payments to reduce provider abrasion?

3 Payment Integrity Features That Can Reduce Provider Abrasion

At HealthEdge Source™ (Source), our commitment to redefining payment integrity and reducing provider abrasion is apparent by the transparency and ease of use our platform offers. We have taken the bold step of rebuilding our original platform from scratch to become the first organization in the market to offer a cloud-based, interoperable payment integrity platform.

The Source solution combines cloud-based scaling capabilities, advanced automation, and an integrated ecosystem of solutions to deliver a robust and effective payment integrity platform.

1. Cloud-based Data Delivery

Our cloud-based data delivery solution streamlines claim processing, shortens payment turnaround times, and reduces provider abrasion. With all medical formats, standards, code sets, claim history, and updates accessible in real-time, Source can eliminate denials and improve claim accuracy. By ensuring your health plan has the most current and secure data available 24/7, you can decrease your reliance on outdated manual processes and fragmented solutions in favor of an effective modern solution.

And with data in the cloud, Source is laying the groundwork for integrated systems, automation, business intelligence, and other advancements in the payment integrity space and beyond.

2. Integrated Platform Ecosystem

Similar to your smartphone, HealthEdge Source’s integrated ecosystem of solutions effortlessly connects multiple claims systems to streamline key functions. Dealing with different vendors with diverse tech stacks, update cycles, and maintenance plans can be stressful. Working with disconnected systems often leads to complicated workflows and greater reliance on manual tasks, increasing operational costs and generating unpredictable outcomes. The single-instance Source solution unifies these elements, reducing administrative overhead, inaccuracies, and recovery costs.

Just as you can easily add apps to your phone, the extensibility of Source allows integration with various third-party solutions—without sacrificing quality. By streamlining these essential processes, Source can empower your health plan to foster smoother provider relationships. This approach enables your staff to focus on strategic initiatives and make more informed business decisions.

3. Advanced Automation And Intelligent Workflows

The integration of automation technologies like Robotic Process Automation (RPA) and Artificial Intelligence (AI) has caused disruptions across industries and contributed to continuous innovations. With Source, advanced automation minimizes user error during the claims process—saving time and money. Automated functions, such as eligibility and benefit verification, prior authorization, and claim management, can help simplify routine tasks, allowing your staff to concentrate on complex tasks that require human intervention.

Optimizing workflow efficiency can lead to substantial cost reductions. Health plans and providers could save nearly $25 billion annually by automating administrative transactions. Source’s innovative solutions not only enhance accuracy, but also transform the claims process, making it a game-changer for health plans and the providers they work with.

How A National Health Plan Reduced Provider Abrasion With HealthEdge Source™  

HealthEdge Source partnered with a large national health plan to streamline their operations as they expanded their government lines of business and automated claims reimbursement. Their existing systems couldn’t handle the complexity of the new government programs, so they turned to Source to help them better manage payments and scale their operations across lines of business.

Today, more than a thousand of their employees use the solution for tasks ranging from claims operations to provider relations. The system can now handle over one million claims per month, even in complex situations. This has resulted in significant time and cost savings, with automations improving accuracy and saving millions of dollars annually. Over our 23-year partnership, the payer has significantly reduced operational overhead and improved first-pass payment accuracy, minimizing risk and strengthening their relationships with providers nationwide.

HealthEdge Source is an innovative payment integrity solution that can address the root causes of provider friction. Our platform gives health plans real-time data access, simplifies claim processing, and leverages advanced automation within an integrated ecosystem. By leveraging Source, your health plan can improve operational efficiency, build stronger partnerships with providers, and achieve significant cost savings. Here

Are you looking for more information on how your health plan can leverage content, technology, functionality, and analytics to achieve long-term organizational goals? Watch our on-demand webinar at your convenience: Avoiding Payment Integrity Pitfalls with HealthEdge Source™.