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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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Matt Martin

Matt Martin

As Web Portal Manager, Matt Martin supports the adoption and successful use of the SKYGEN USA family of companies’ web portals by providers and members. Mr. Martin ensures the strategic functionality of the web portals, which play a critical role in streamlining benefit management and reducing cost. His current focus is on promoting provider use of the portals in order to increase administrative efficiency.

Recognized for his ability to build confidence and rapport, Mr. Martin is skilled in managing successful relationships with clients and their providers. He is a talented problem-solver, and brings an effective teaching style to his role. Prior to joining SKYGEN USA, he taught high school mathematics.

Mr. Martin volunteers his time as a coach for youth wrestling, baseball and flag football. He holds a Bachelor of Science degree in Secondary Education-Mathematics from the University of Wisconsin-Eau Claire.

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