Proven Leading Practices for Health Insurance Operations
Health Insurance Best Practices Guide
Learn MoreImprove Customer Satisfaction by Providing Resources that Helps Determine Which Providers are In-Network
Best Practice (Good)
Provide policyholders the resources necessary (typically done through the company's website) to determine which providers are considered to be in-network for the policies they are currently a part of. Periodically contact policyholders (through email, letters, etc.) to update them on any changes to the in-network list. Ensure that policyholders understand that asking a doctor, lab or hospital if they are in-network should not be relied upon. Furthermore, use feedback from policyholders to identify gaps in the firm's network of providers and inform network development efforts.
Typical Practice (Bad)
Provide policyholders with a list of in-network providers on the company's website. It is the responsibility of the policyholder to sign into the insurance company's website and conduct their own searches.
Benefits:
Starting in 2014, the size of in-network providers shrank due to the Affordable Care Act (ACA). Though these "Narrow Networks" were created to control costs by providing physicians, labs and hospitals lower reimbursements for services, a significant portion of providers rejected the lower fees offered by insurance companies. As a result, insurance companies should strive to provide policyholders with as much information (typically through online resources on the company's website) concerning which providers are part of their network. This not only prevents policyholders from being subject to a separate, typically larger, out-of-network deductible and out-of-pocket payments, but also increases customer confidence and satisfaction with the company.
Educate Providers on Effective Patient Data Collection to Improve Data Accuracy
Best Practice (Good)
Educate providers thoroughly on methods for effective patient registration and data collection during office visits, providing them with a comprehensive picture of how an insurance claim is processed by the carrier and the consequences of inadequate patient data collection on the front-end (constant customer contact, incorrect claim distribution, etc.). Require that providers allow returning patients to review all of their information (address, employment, insurance account, etc.) for accuracy before each visit.
Typical Practice (Bad)
Rely on providers to capture patients' data using a one-off, method (typically unique to the provider) and contact them during the claims management process to correct incomplete or incorrect information. Require providers to ask returning patients if any of their account information has changed since their last visit to ensure that their information is up-to-date.
Benefits:
Educating providers on methods for effective patient registration and data collection during office visits reduces the overall claims processing cycle time and the administrative cost incurred per claim by ensuring that healthcare providers accurately and thoroughly collect patient information. Ensure that providers are provided with a comprehensive picture of how an insurance claim is processed by the carrier and the consequences of inadequate patient data collection on the front-end (this can include constantly contacting patients or providers to fix incomplete or incorrect information which prolongs the claims processing cycle times, distributing claims to incorrect patients, increased instances of rejected claims, etc.). Improving the accuracy of collected patient data, furthermore, improves the timeliness of outgoing provider payments by reducing instances of claim rejections and postal returns on patient invoices.