Skip to main content

All-payer connectivity: 3 ways to close the gaps between providers and payers

In this digital age, one of the biggest challenges in healthcare is staying connected. The need for healthcare interoperability is only getting stronger, so having a seamless connection is becoming even more important. With better, secure access to real-time patient and payment information, both financial performance and the patient experience improve.

Each patient claim contains a wealth of information. Improving the submission of accurate claims data increases first-pass yield and cash flow.

Technology interoperability closes the gap

To be successful, providers must overcome these payer connection challenges:

    • Outdated clearinghouses that may still require significant manual intervention and logging into multiple systems
    • Lack of visibility or understanding of payer rule changes resulting in claims denials and reimbursement delays
    • Potential payer setup issues, including difficult implementations for new payers or having access to a limited payer network

Providers need to be able to easily submit claims for reimbursement, receive visibility into claim progression and receive timely payment information from all payers – including Medicare and commercial – to streamline billing, remain compliant and get faster reimbursements.

How is your software currently closing the gaps between providers and payers? Both are looking to you for that seamless, interoperable technological connection. Having timely and consistent access to claims processing information from payers is key to making insightful decisions to increase cash flow.

Improving technical interoperability between payers and providers helps to alleviate margin pressure from your customers.

Real-time data supports provider revenue cycles and the payment experience

Claims management is only as strong as the data it’s built upon. You may already offer your customers financial analytics from various sources, but does it convert into quality, actionable data to improve RCM performance? Without access to comprehensive claims coverage and eligibility information, providers lack insight into payment trends and KPIs that ultimately affect their bottom line. Providers also lack the resources to search for all the claims and eligibility data that could help increase revenue. This may bring in high dollar claims, but money is still being left on the table.

Now more than ever, access to complete, real-time coverage and eligibility information is critical for providers to accurately manage claims and deliver higher care quality. Having complete visibility into claims and remit statuses, eligibility and real-time reporting could expedite claims processing and accelerate reimbursements for your customers. To improve care quality for patients, providers need access to complete, consolidated patient data in a single location. A comprehensive record of a patient’s medical history will help your customers generate appropriate care plans, increase efficiency, and deliver higher-quality care.

And when you combine patient data with enhanced coverage and eligibility information, your customers collect payments quicker and offer patients a better experience, too. Invicta Health Solutions, a hybrid technology and professional services company, found the most impactful strategy to put claims data to good use. Click here to see it for yourself.

Automated workflows maximize staff efficiency and cash flow

Healthcare’s new reality is exhausted staff. Provider staff turnover has reached unprecedented levels, so how can you help? Instead of encouraging your customers to hire more, suggest they replace manual processes with technology. And then help them do it.

It’s time to automate time-consuming workflows and allow providers to focus on real-time revenue forecasting and a proactive approach to regulatory changes, while keeping the patient a top priority. Combine that with fast, reliable connectivity between all payers and all providers, and watch as both efficiency and accuracy improve. To hear a real-world account of technology in action, listen to this insightful discussion featuring two RCM experts as they uncover how Inovalon technology is impacting their current and future revenue cycles.

When you partner with Inovalon, you gain nationwide connectivity between all payers (commercial and Medicare) and all providers, the industry’s largest primary source real-world dataset, and automated, efficient RCM workflows.

Your next steps in closing the gap

Watch this video to learn more about technology’s role in healthcare.

Connect with our partner team! Learn more here or call 855-915-1436.

About the author

David Swenson, Manager, Sales Engineering