Healthcare Providers Now Perform Real-Time Patient Eligibility Verification

Ruzanna Harutyunyan's picture
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SunTrust Banks, Inc. (NYSE: STI) today announced a new healthcare receivables solution for medical and dental practices of all sizes, as well as hospitals. SunTrust eClaim Revenue Gateway helps providers accelerate insurance claim submissions as well as payment collection and processing so that they can focus more time and resources attending to patient healthcare needs.

eClaim Revenue Gateway is a secure, full-service online solution that in a single platform offers providers the ability to streamline and expedite the claim-to-payment process - from eligibility verification and claims submission to payment receipt and reconciliation of claims data.

"We hear from our healthcare clients that they continue to be challenged with managing electronic and paper claim submissions and then reconciling the associated payment and remittance data - all while dealing with multiple health plans, disconnected systems, and regulatory and privacy mandates such as HIPAA," explained David Fuller, executive vice president and division head, Treasury & Payment Solutions, SunTrust. "With eClaim Revenue Gateway, clients are better able to integrate the claim process with the payment services traditionally delivered by a financial institution, thus providing opportunities for increased operational efficiency and faster access to cash receivables."

One of the greatest benefits of eClaim Revenue Gateway is its ability to perform real-time eligibility requests on behalf of the healthcare provider. The service also provides online access to view claim status and to manage the claim denial process. Through a comprehensive program which includes the real-time eligibility verification, a rigorous upfront claim submission vetting process, and online access to claim status, the rate of rejected claims with eClaim Revenue Gateway is substantially reduced.

"In today's economy there's an increased urgency to accelerate collections," added Nick Alex, senior vice president and director of product management for SunTrust Treasury & Payment Solutions. "Currently, though, the average medical or dental provider has between 60-120 days of outstanding claims on their books. eClaim Revenue Gateway brings a much-needed improvement to this process."

Providers can use their existing claims processes and systems, or SunTrust eClaim Revenue Gateway software, to upload their electronic claim file, and SunTrust will securely transmit the claims to the full range of participating third party payers. eClaim Revenue Gateway then reconciles payment advices received both electronically and by paper copy. Paper advices received at a SunTrust lockbox are imaged and optical character recognition (OCR) technology converts the required data for electronic processing. All payment advice information is combined and compared to the provider's submitted claims. A fully reconciled electronic file is then created, which providers can easily integrate into their existing practice management or hospital information system for posting - helping keep financial records more current.

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Additional benefits of eClaim Revenue Gateway include:

* Greater flexibility. Multiple implementation options can better meet providers' specific needs and existing systems currently in use.

* Minimized errors. Erroneous, duplicate, and incomplete claims are reduced during the screening provided by the solution.

* Maximized cash flow. Claims-on-hand and average claims-to-cash reimbursement cycle days can be reduced, allowing faster posting of funds.

* Improved workflow. Eligibility verification and claim substantiations can be processed faster; bad debt and collection issues can be reduced.

* Increased access. More than 1,200 insurance companies (payers) are connected to the system.

* Enhanced reporting and tracking. Providers can trace submitted, accepted and rejected claims by patient, payer and procedure codes - or by nearly every data element of a claim, minimizing time spent researching.

* Simplified usability. Intuitive navigation and hover technology facilitates faster access to payment and claim data within the solution creating a positive user experience.

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