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Insurance software that improves the provider experience gives payers a competitive advantage

By Patrick Ruesch

SKYGENUSA Powering Healthcare for the Digital Age


Much has been written in the last few years about how payers need to use insurance software to improve the customer experience in order to attract and retain members. Especially with the addition of millions of individual member policies as a result of the Affordable Care Act (ACA). Not to mention the increased importance of patient satisfaction scores.

Yet there is another group that is just as important to payer success whose user experience needs to be considered carefully as well – the provider network.

Creating the ultimate provider experience should be a strategic priority for all payers. After all, the provider network is the critical link between payers and members, and members are often much more invested in their choice of provider than their choice of payer. So it stands to reason that if payers can attract and retain more quality providers by delivering a better experience to them, the payer’s business will grow as a result.

The goal is to create an environment where payer/provider collaboration is optimized and the benefit administration burden is minimized on both sides. Being a good partner to the provider community means they can focus on what is most important – delivering efficient and effective care to their patients/your members.

Never-ending need for innovation

One of the most important contributors to exceeding provider expectations (and gaining a competitive edge) is continuous innovation through the use of technology. It isn’t enough to create something new every now and then. Because each new capability you add quickly evolves from being the Next Big Thing to the new minimum requirements.

Staying ahead of the benefit administration technology curve and identifying additional options to improve the provider experience ensures that your organization is viewed as a leader and a more desirable business partner than payers who lag behind.

Building an electronic relationship

One of the best things payers can do for providers is replace outdated, manual systems and processes wherever possible with automated, electronic capabilities for all transactions. Some examples include:

  • Optimizing web portal capabilities – Providers want to help themselves, but if web portals and websites aren’t intuitive providers will likely skip using the portal and call instead. That’s a waste of time and money for everyone. It’s not enough to provide access to information and the ability to complete transactions electronically. These operations must be easy to perform to encourage providers to engage in a deeper electronic relationship.
  • Offer daily check runs – Timely claims payment is integral to provider satisfaction. Performing check runs on a daily (rather than weekly) basis ensures providers receive reimbursements as quickly as possible – a sure way to improve their satisfaction and gain favored status.
  • Encourage the use of other time-saving technologies – Payers can build stronger relationships by tying into and encouraging the use of technologies outside their own four walls. For example, the American Dental Association (ADA) is introducing a new credential registration web portal that enables dentists to enter their credentials once and them have them accessed on-demand by multiple payers for the dental networks. That is far more efficient for dental providers than having to fill out individual applications each time they want to join a new network or renew with an existing one. Demonstrating a commitment to using these time-and-labor-saving options will encourage providers to join your network – and stay there.

More than benefit administration technology

While an electronic relationship is a key differentiator, you don’t want to ignore the human side. Providers are people too, with very human concerns. Some ways to strike this balance include:

  • Be prepared to address special requirements – Have dedicated staff available should an issue that requires the human touch arise. Delivering prompt and personal attention when electronic options aren’t enough can make a huge difference in providers’ perception of your organization.
  • Always be learning – Consider establishing a provider advisory board and conducting quarterly meetings. Discussing current issues and collaborating to address concerns is a great way to connect with your providers. You will gain invaluable insights that will help you focus on the areas your providers believe are most critical to their satisfaction.
  • Support them in their communities – Look for opportunities to attend, support and sponsor special events such as community care days. That type of collaboration goes a long way toward establishing the deeper roots within the provider community and demonstrating that you are a concerned, caring partner.

Worth the investment

While no official agency is measuring provider satisfaction, its importance cannot be overstated. Providers today expect payers to be ahead of the curve relative to improving the provider experience. Right now they see virtual transactions as a differentiator; tomorrow it will be seen as the norm.

Consistently delivering a world-class provider experience through innovative insurance software enables them to deliver needed care in the most efficient and effective manner possible. It is only then that providers can focus on what is important to them, and what should be important to you: improving the health and well-being of the people we all serve.

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Patrick Ruesch

Patrick Ruesch

As Director of Provider Services, Patrick Ruesch brings a client-centric focus to the development and management of successful provider networks for Scion Dental clients. He oversees the Network Development, Credentialing, and Provider Services departments, ensuring Scion Dental maintains networks in alignment with the requirements of each client as well as the National Committee for Quality Assurance, and delivers a high quality of service to providers.

In his role, Mr. Ruesch is responsible for creating innovations that help ease the process of benefit management for provider communities. He provides leadership in identifying, developing and implementing provider management best practices and problem resolution. He collaborates with Scion Dental’s Chief Operating Officer on strategic initiatives to better align the departments to meet organizational objectives. He also works to foster an environment of continuous improvement though process and systematic efficiencies.

Mr. Ruesch brings nearly three decades of experience in the health insurance industry to his role. Prior to joining Scion Dental, he served as Global Operations Manager for Ingenix, a leading health information technology and services company and a business of UnitedHealth Group. His areas of expertise include network development, provider relations, claim operations, training and development, call center operations and global operations.

Mr. Ruesch holds a Bachelor’s Degree in Economics from the University of Wisconsin – Milwaukee.

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