Evaluate Payer-Provider Portals on These 4 Features

Go beyond the basics with a payer-provider portal that drives engagement and decreases costs.

How would you characterize the health of your relationships with network providers? If yours is like many health plans, those relationships could always improve. And providers agree, with a relatively high number of them reporting low levels of trust in public and private payers. Without collaboration, the shift to value-based care and the coronavirus crisis could push these strained partnerships beyond their limit. But payer-provider portals may provide an answer to this dilemma. Increasingly, health plans are using them to come together on claims payments and other communication needs.

How to Choose a Payer-Provider Portal

When providers rank top payer performers, they reveal a link between efficiency and trust. Those health plans that simplify claims processing, offer transparency in their transactions and are quick to reimburse will win these relationships. With these goals in mind, we identified 4 features your payer-provider portal must have to drive engagement and increase revenue.

1. Overpayments and underpayments

Both health plans and providers want a clean claims process that reduces the administrative burden and speeds reimbursement. The current process at most payer organizations relies too heavily on paper-based, manual activities that lack context and create abrasion. Portals provide the opportunity for two-way, real-time secure communication that eliminates the need for fax and mail.

At the most basic level, your portal should support both health plan auditors communicating on overpayments and providers reporting underpayments. Providers need to quickly see the status of all claims, including visibility on medical records requests and details on denials and appeals – down to the line level. Form letters don’t include this context, requiring follow-up phone calls that add even more inefficiency to the process. But combined with alerting for claims that need input, the payer-provider portal workflow accelerates audit resolution.

2. Credit balance, recovery posting and reconciliation

A recent survey confirms providers find revenue cycle management most in need of innovation and disruption. But they also said lack of alignment between healthcare stakeholders – including payers – could stifle progress on this front. Payer-provider portals hold the potential to ensure clean accounting systems for both sides of the equation.

For providers, an at-a-glance view on their total claims with you, broken down by those pending, accepted, denied and in review is essential. They also find value in the ability to identify and resolve credit balance issues. As providers accept denials, this should automatically initiate recoupment and recovery on the payer’s side to ensure full overpayment tracking and reconciliation with no gaps. This seamless process should extend to unsolicited refunds as well.

With all of these activities connected, payer auditors get a view on the net recoveries and claim spend in real-time. Full analytics on the effectiveness of these activities – reports, dashboards and a payment forecast – increase this value.

3. Seamless integrations

Providers – like many in healthcare – operate with arguably too many siloed tools. They may already use multiple portals to work with various payers. Many health plan auditors work in a similar environment. Jumping in and out of several disconnected systems wastes time and leads to mistakes. But payer-provider portals that minimize additional burden on this front benefit both sides of this relationship.

For providers, the ability to connect the portal with their EHR allows for increased efficiency on medical records requests. They can see helpful information from both sources at their fingertips and quickly access exactly what they need for each task for faster, more reliable processes. For auditors, keeping the portal on-platform with their current auditing workflow minimizes repetitive tasks and speeds turnaround times. This integrated framework is especially useful for the accelerated timelines of prepay audits

4. All-in-one information access

Think of all the different ways you communicate with providers and deliver information. And yet, over 30% of providers report not communicating with payers at all. No wonder providers and payers both feel these relationships lack alignment. With information constantly changing, the payer-provider portal holds potential to act as a single source of truth.

Use the portal to distribute always-up-to-date provider manuals, procedures, correspondence, newsletters, how-to guides, and other provider education and communications. In return, providers don’t have to manually complete forms and figure out how to submit them or worry that out-of-date information will prevent timely claims payment. With dashboard notifications that promote self-service, providers and health plans can stay on the same page.

Pareo Payer-Provider Portal Increases Engagement and Revenue

The relationship between health plans and providers requires more collaboration than ever. As our industry shifts toward transparency, you need a technology platform that supports that goal.

A payer-provider portal like Pareo Provider can help you demonstrate value on the fundamental communication needs of claims payment accuracy. Reduce the administrative burden. Make it easier to respond to medical records requests. Provide context on claims overpayment submissions and respond quickly to underpayments. Increase efficiencies for health plan auditors and revenue cycle managers alike. This foundation of trust paves the way to coming together on initiatives of greater strategic significance like value-based care.