Solutions for Healthcare

The implications of HIPAA implementation are just now addressing the emerging needs for Electronic Remittance Advisory (ERA) payments — i.e., HIPAA-compliant medical payments.

As of October 1, 2006, Medicaid no longer allowed the use of paper remittance for any provider that has elected to receive ERAs (Electronic Remittance Advice).   Many health plans are also requiring that their provider network utilize electronic transactions, including ERAs.  An inherent part of the ERA — which is basically an electronic version of the explanation of benefits — is the inclusion of payment information and, ultimately, the coordination of payments. The ERA’s value is diminished anytime it is delivered without payment information.

Spearheaded by healthcare clearinghouses, the AMA, the ADA, CMS, practice management system vendors, state societies, and industry organizations are all pushing to derive a method whereby the provider and payer can do what they do today, and the clearinghouse also takes on the role of being an EFT / ACH clearinghouse, coordinating payments with the claim (after all, it is most logical at this point in the claim processing process).

The bottom line is that the ERA cannot be effective without the coordination of payment information.  Additionally, the ERA will eventually or are already be mandated system-wide: providers will be a part of the carrier network only if they are willing to receive ERAs instead of paper.

A More Efficient Future

So far, Medicaid is leading the charge. Carriers will follow suit, as the check printing and Explanation of Benefits (EoB) printing processes are inherently far more expensive than their electronic counterparts. Carriers now are addressing the objectives of lowering operational overhead for mail room, customer support, imaging and printing systems, and so on.

This was not true in previous years because new process implementations mandated by HIPAA, HITECH, ARRA and other similar regulatory mandates, overwhelmed the industry. In 2006, many payers were already offering non-monetary incentives to providers who are willing to give up paper remittance for ERAs. This shift in priorities that are now being addressed by providers of all size, has tidal force.

The Greenlist solves an important problem that is a barrier to full and speedy implementation of HIPAA 835/ERA payments: the reluctance of healthcare providers (i.e., physicians, dentists, and others) in providing their bank account numbers in fear of claw-back adjustments from insurance companies.

Confidentiality of Patient Information

Payment Pathways’ technology also addresses a unique way to enable the global telecommunications infrastructure to use telephone numbers as pointers to payment addresses, personal healthcare records, and other personal information demanding secure treatment. This approach combines the ENUM protocol and architecture with Payment Pathways’ Greenlist infrastructure.

For example, this technology can be configured to give consumers the ability to grant access to their healthcare records to their healthcare providers, as well as to emergency first responders, while remaining within a straightforward security model. This real-time notification of third-party data requests gives the individual far greater control over access to personal information, using the same authorization process the individual is already using to approve a payment.