E-Billing Expose – Part Two

In my previous post, I discussed E-Billing and its impact on a Healthcare Payer or Life/P&C/Worksite Marketing Insurer and alluded to levels of E-Billing I’ve seen in my travels.

Level One is the simplest – really just E-Bill Presentment. Sometimes this is a PDF of the bill emailed to a customer (privacy alert!), but usually it’s the customer logging into the insurance company’s web site and viewing a copy of the bill, with the ability to print. On the positive side, this approach does shorten the billing cycle by avoiding the mail.  From an IT standpoint, this is a print-driver substitution (I know, I exaggerate, as simply printing a bill is a very convoluted process for many insurance companies), but yes, many companies (and many consultants!) call this E-Billing. From a technical/transaction standpoint, this is the simple equivalent of brochureware for a web site.  There is no process efficiency gain by either the company or the customer.  The bill goes out, a check comes back.  All the manual processes stay in place.

Level Two is a step up, albeit small – E-Billing Presentment and Payment.  This method provides the same information as Level One with the ability to submit payment via Electronic Fund Transfer (EFT) or credit card.  The lockbox can be cut out and the payment processing steps bypassed, but the payment will again, never match the account by the time the two are matched.  Too many changes occur in the gap between bill generation and bill payment.

So it comes down to Level Three, the real payback generating use of technology – RECONCILIATION.  In the industry this is called E-Billing Presentment, Reconciliation and Payment.  These are the systems where I’m seeing companies and their customers make huge leaps in efficiency.  You need three ingredients for this recipe:  (1)  the back office system, (2) web self-service and (3) true system integration.

The back office system (regardless of brand, platform or computer language) must be kept sterile as the “system of record”.  It generates the bills through the application of business rules, dates and rates.  The E-Billing System, through integration and custom software, captures this bill and builds a live webpage with embedded links to portions of the bill the customer might need to change for reconciliation purposes.

The customer is notified the bill is available and logs into the company’s website to access the bill at their convenience.  Clicking on an employee’s name might bring up the ability to add a dependent to that employee record, or change their employee class, etc., etc., with each change resulting in a modified premium amount for that line item.  Links are available to add new employees along with their start dates, invoking a pro-rating routine to calculate the premium.  Each time one of the hundreds of possible reconciliation changes are made to the bill, the bill recalculates, the total changes and the change is marked for easy review.  Behind the scenes, the system builds a set of transactions representing all of the reconciliation changes.  When the customer is finished and the bill is balanced to their satisfaction, they finalize the bill by selecting a separate link.  This locks the bill and feed the changes to the back office system through the final set of integration routines.  The customer is given the opportunity to pay electronically.  The bill and the back office system are in balance and all is good in the land of E-Billing.

What doesn’t happen?  A “marked-up” bill is NOT sent back to the company to be manually reconciled.  A payment for the wrong amount is NOT posted, resulting in additional debits and credits.  Phone calls and emails do NOT fly between company and customer accounting departments.  The next bill is NOT wrong before it is generated.  Most compliance issues are avoided as the bill controls the census, thereby controlling the premium, so there are no misunderstandings about who was paid when, resulting in a much cleaner claims process.

Of course, the Level Three description above is a very simplified view of this process.  There are many, many back office systems, most have been modified since installation and some are even no longer supported by the vendor.  Legacy systems abound. 

Selecting a true system integrator with expert knowledge of the business is the key.

Image appears courtesy of weblogcartoons.com

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