Top 5 Mistakes in Claims Management – And How to Avoid Them
Claims management accuracy and efficiency are crucial for hospital billing, accounting and finance professionals. However, common missteps can cause...
Imagine if the power of health plans could truly be unleashed. If they were fully invested in improving the health of the lives they serve, connecting members to meaningful wellness tools, helping people navigate complex healthcare networks, supporting caregiver planning and even finding the “right” surgeon. The member centric utopian state. This is not easy to do when health plans are weighed down by claims adjudication and management of dynamic provider relations.
Core business tools in the form of people, process and technology help health plans increase efficiency, decrease spend and avoid costs, giving you the freedom to make this utopia a reality. But for starters… you must know your members, including all insurance coverage they have through your plan or others.
Consider this: Four in five Medicare beneficiaries have secondary insurance. In 2020, there were 62.6 million Americans enrolled in Medicare, which means roughly 50 million have secondary insurance. This is simply too many to ignore, identify manually or attempt to get money back post claim payment.
The Secondary Insurance Disconnect
As you know, not all health plans cover every healthcare cost. This is exactly why the Aflacs of the world exist, with their duck mascot hopping around in their fun commercials, talking to football coaches. But there’s a serious disconnect here that is putting health plans at a disadvantage, causing a negative economic effect that can ripple across the healthcare and plan continuum impacting contracting, costs of care, provider relations and member experience. Secondary insurances are difficult to see at the member level, and these businesses have no incentive or desire to share their lives covered to health plans covering a person’s core medical, dental, vision and other ancillary health needs.
The problem is that many health plans won’t notice other insurances until it’s far too late, having already paid a claim to the servicing healthcare provider for services that the health plan itself may not cover. This can cost health insurance plans millions of dollars a year, greatly impacting projected revenue and, eventually, provider contracting, relations and client rate increases.
Discover Secondary Insurance Before Paying the Claim
Health plans need to know what other insurances a member may have to ensure claims paid are only for services covered by that health plan. Understanding a member’s full coverage prior to claim payment can save you time and money in both cost avoidance and reduced administrative burden. If we can solve this, we will see a shift in even more member centric solutions, advancement in health and closing gaps in care. In short, health plans will be able to provide better care to more people for less money.
FinThrive’s Insurance Discover solution can help health plans lower their overall Per Member Per Year (PMPY) spend with an ROI greater than 10:1 by:
- Finding and verifying other coverage, helping you determine the correct Coordination of Benefits.
- Providing visibility of claims to reject, and the other insurances aligned to member and services rendered.
- Allowing you to see secondary insurance termination and activation dates giving you more precision.
For health plans to be truly member centric they need to be free from high friction, labor intensive transactional activities, such as tracking down inaccurate claim payments due to other member insurances or managing tense, high stress healthcare provider relationships. If we can help each other nail the basics we can solve this specific challenge and focus on the people side of health.
This is our opportunity to truly advance health of populations. For more info on FinThrive’s Insurance Discover solution for health plans, please Contact Us.
