Claims Management and Insurance Verification

Hello. My name is David Gutierrez, and I'm head of the customer onboarding team here at FinThrive. In an effort to support you through the disruptions you're experiencing at the Change Healthcare outage, our onboarding team has developed some rapid deployment options to help you move to our claims manager solutions quickly. The three options we have available are essential accelerated, essential plus and advantage. So let's take a deeper look into these three options.

So essential accelerated, it's our fastest option to have you up and running to get claims out the door in as little as 14 days. This plan includes an insurance master setup, up to three pairs that require EDI enrollment, default duplicate and conflict checking, manual claims, attachment uploads, and two virtual training sessions. Now what this plan does not include is outbound files, integrations to other systems, bridge routines and custom edits. Next, we have our Essential Plus.

This plan includes everything that's in the Essential Accelerated plan, but it's for the customers looking for a little bit more set up and some light customization. We expect these implementations to take probably around 45 days just depending on that scope of work. Last, we have that advantage plan. So this is for the customer that's looking for more complex scope and customizations, and the timeline will vary based on what we find in the discovery and scope process.

 So, to kickstart these implementations, we simply need you to complete the business process questionnaire, receive a copy of your insurance master, complete the discovery and scope business process and engage with your customer relationship director or your assigned customer success manager. You can begin this by reaching them at mysuccess@finthrive.com or finthrive.com/accelerate.

So now let me hand you over to Joel Hubbard, our VP of product management, to talk about our insurance verification model.

Thanks, David. Today, I wanna introduce three potential options that can be rapidly deployed from FinThrive for an insurance eligibility perspective to allow you to restore connectivity and be able to be up and running and verifying electronically.

We have three solutions available as I mentioned. The three solutions are health care solutions portal, fast file processing, and real time 270/271 in increasing levels of complexity of the deployment.

All three give you access to 880+ pair connections that FinThrive has today. We do have the healthcare solutions portal, which allows manual entry about singular eligibility and benefit inquiries into a portal. It can be deployed in as little as one day, and it doesn't require any provider IT involvement.

The batch file process is for those providers that don't need real time and wish to pro to process a greater number of transactions at one time. Those providers can submit via a secure file transfer protocol, be able to meet our specifications for both inbound and outbound and be up and running in as little as two business days.

This does require provider involvement because you will need to do secure file transfers. You'll need to build the batch files and those types of things. Finally, for those providers that are looking for a real time experience similar to what they normally have, we have our real time 270/271 connection. This allows you to communicate with us directly via x12 270 and have received a x12 271 response. This would be delivered via an HTTPS web service connection and can be deployed in as little as three business days. Again, it will require some IT involvement to help facilitate the setup of the connectivity, pair mappings, and integration with the real time engine itself. All three of these do require some payer enrollment at times. This is selected. It's not all pairs that will require this, but there are some in one high volume, one is CMS. CMS is currently taking about three days to approve a payer enrollment, which means that within one to three days, you should have most of your payers up and going, but some may take a week or two in order to get up to speed.

Just to quickly demonstrate what the solution looks like, you see the health care solutions portal in front of you today. Health care solutions portal does support looking and searching for an account or coverage by service type code and by payer. You then can enter in the basic demographic information and get a rapid snapshot answer to, is my patient covered or not covered? Is there insurance active or inactive?

You need to dig a little bit deeper, you continue to scroll down the screen, and you can see the service type code by service type code responses, as well as the benefits. So you can see active coverage and inactive coverage. And down at the bottom, you can see the deductibles and things like that.

Shifting to the batch file, I mentioned that we have a standard list of specifications.

This is an example of those specifications on the screen here. You can see it's very simple. Payer ID, provider ID, and then provide the demographic information that is required in order to check eligibility.

The return file to you will mirror back that same information, plus any edits that the the payer provides when it comes to patient's name or anything like that, including also bringing in plan types, plan start dates, benefit information, and even, other eligible pairs that are on file with that particular payer.

Finally, the integrated two seventy two seventy one process is designed such that you can work in your system that you're used to working in today. You can process a transaction with us in real time with the push of a button or whatever the usual processes are that you follow. So you you will get your responses back in two to six seconds, and you'll be up and running in no time.

As we close out, I just wanna remind everyone that there are multiple ways to contact us if you need more information. The first is to email mysuccess@finthrive.com, and the alternative is to go to finthrive.com/accelerate and complete the form that's the intake formats on that screen.