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Offline and Falling Behind: The Risks Healthcare Providers Take In Failing To Adopt Benefit Administration Technology

By Matt Martin 

SKYGENUSA Powering Healthcare for the Digital Age


I doubt that when many dentists first dreamed of going to dental school that checking patient eligibility, submitting insurance claims or chasing down payments is what they pictured. Given how time-consuming and painful those tasks can be, you’d think they would leap to sign up for free online portals that do the job faster and more efficiently. But in many cases you’d be wrong.

The reality is many still cling to the old ways of paper forms, phone calls and snail mail. Within our own payer client base, almost 64% of their payees have registered for their provider web portals. That means a little more than 1/3 still have not.

To me, that’s mind boggling. It’s like filling out your taxes by hand instead of using a computer program, or waiting until the bank opens to get some quick cash rather than visiting an ATM. Sure, change can be difficult, especially if you’re not particularly technology-savvy. But this is a case where change can make a positive difference in your administrative workflow as well as your cash flow.

It’s also important from a competitive point of view. In today’s instant-everything world, patients lack patience. If you can’t accommodate their schedules because it takes too long to do what you’ve always done, they’ll find another provider who can. And you will be left in the dust.

The truth is there are all sorts of benefits to registering for – and using – a provider web portal. Here are some of the most significant.

Faster authorization of services, other paperwork

With a traditional, paper-based system it can take five to seven business days to fill out the forms, mail them and then finally receive authorization to perform a service. That’s an excruciatingly long time to wait in the digital era.

You can fill out and submit forms on a portal in minutes, and cut the end-to-end time down to 24 to 48 hours, speeding the entire service delivery ecosystem. Looked at another way, in the time it takes to receive a paper authorization for one patient you could have already started or completed the work on several. That alone should make it an easy decision. It does what clearinghouses do – but for free!

This same principle applies to all the other forms (such as claims) you have to submit as well. A few minutes on a portal can cut days out of the equation.

Get paid faster by reducing errors on claims

Using a provider web portal to file claims can be a real game-changer in another way.

A good electronic claims system will actually catch most errors for you, calling them out for review so corrections can be made before submission. We recently added a new continuous processing capability that moves error-free claims into the payer’s system automatically, eliminating the time lost waiting for a person to perform that task – extra incentive for filing claims correctly the first time.

Here’s an example of the difference a portal can make. A very large group of providers was having issues with their mailed claims and authorization requests being denied due to missing information. We set up all 25 of their locations on a provider web portal and trained their personnel on how to use it. Because the portal guides them through the process, telling them what attachments are required and calling out when information is missing, they are no longer receiving those types of denials.

Another thing to keep in mind is if you’ve enabled electronic fund transfer (EFT), a claim can be paid within 24 to 48 hours. Which means you can already be paid in the time it takes for a paper claim to be mailed and received. That seems like a no-brainer.

Reduce wasted time on the phone

Making phone calls to check eligibility and following up on the status of claims and authorization requests can use up an inordinate amount of your administrative staff’s time. Moving onto a provider web portal allows your staff to search for and find the answers themselves quickly – versus calling customer service and waiting for them to look up the information in their system.

How much of a difference can this make? One provider with 11 locations was averaging 375 phone calls per month – more than double the next-highest group. When that provider registered for and began using the payer’s provider web portal, their volume dropped below 75 calls per month. That is a huge gain in efficiency.

Improve security

One reason technology-averse providers give for not using a web portal is they are concerned about security of protected health information (PHI). In truth, it is actually safer to submit information through a secure web portal than to expose it to a manual mailing process that takes three to five days – particularly when the portal has the high level of security we employ in the Wonderbox Technologies Enterprise System.

Storing your data electronically on a portal that is backed up instead of in manila folders in a file cabinet also protects it much more effectively from fire, flood or other disasters.

Get instant updates

With a portal, providers can view any new information, updates or manuals payers release as soon as they are made available rather than waiting for it to arrive in the mail. If providers remember something new came out but can’t recall the details, they can search the portal and pull it up instantly, again allowing them to spend less time looking through paper and more time on patients.

Don’t get left behind

Many of your competitors are already taking advantage of what a provider web portal has to offer. Do you really want to be left behind eating their dust? A good portal technology company will help you ease into it and train your staff in its use. After a few weeks, you’ll wonder how you ever did business any other way.

Have you moved onto a portal yet? If so, what has your experience been? Was it easy or difficult to make the transition? Has it helped streamline your business? Leave your thoughts in the comments below.

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About Dr. Judy Greenlea Taylor

Dr. Judy Greenlea Taylor, a native of Atlanta, GA has practiced dentistry in the public and private sectors for 28 years and currently operates a private practice in Union City, southwest of Atlanta. In addition to her ongoing role as practitioner and CEO of Greenlea Dental Center, PC, she serves as Dental Director for CareSource, a nationally recognized nonprofit managed care plan, serving Medicaid, Marketplace and Medicare beneficiaries in several state markets. With direct oversight and management of the Georgia Market dental operations, Dr. Greenlea Taylor provides strategic direction and development for dental policy and program design to ensure access to quality oral healthcare. She additionally, provides oversight of professional clinical review, quality management, utilization management and dental professional relations.

Dr. Greenlea Taylor’s extensive career includes key leadership positons and roles. These include serving as the 92ndPresident of the National Dental Association (NDA), a Consultant to the Department of Health and Human Services (HHS), a state board official appointed to the Georgia Department of Public Health by Governor Nathan Deal, where she served two terms and served as an Officer - Secretary. As the only dentist on the Board, she advised the Commissioner and department on issues related to oral health, policy and programs to improve oral and overall health in Georgia.  She additionally serves on numerous other boards and committees at local, state and national levels. She is a nationally recognized public health educator, lecturer and consultant.

She has received numerous honors and awards for both her professional and community service accomplishments. Some honors include esteemed fellowship into both the American College of Dentists and International College of Dentists. Atlanta’s WXIA TV 11ALIVE  Community Service Award; Outstanding Citizen Award from Secretary of State Brian Kemp (2015), affording her every courtesy as a Goodwill Ambassador from Georgia; proclamations and commendations from the State of Georgia, the City of Atlanta, City of Union City and the Georgia Department of Public Health. In addition, most recently, Hidden Figures Award recipient, honoring Women Leaders in STEM.

Dr. Greenlea Taylor earned her Bachelor of Science degree from Prairie View A&M University (Texas A&M University System) and historically was the first graduate of the Benjamin Banneker Honors College. She earned her D.D.S dental degree from University of Iowa, completed a General Practice/Oral Surgery Fellowship Residency at Emory University and a Master of Public Health Degree (MPH) from Emory University Rollins School of Public Health. She received course certification in health disparities research from Columbia University and a certificate in Cultural Competency with HHS, and serves as a facilitator trainer.

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