In a previous post Healthcare Transactions: Simple?... Not yet, we talked about how healthcare technology and the process of transferring information needs to be updated. We will discuss how updating this technology in the benefit administration industry can help fix this problem, change the industry, and empower the consumer.
Imagine if a patient (not a benefits administrator) were able to make changes to his or her health insurance policy more than once a year or when a ‘life event’ takes place? Currently, this is not possible. Why not? Read on...
Health insurance data has to go through multiple company systems to make even the most minor changes. Further, there are a lot of cooks in the kitchen! Let’s use PokitDok as an example. We currently offer Aetna to our employees and Zenefits serves as our benefit administrator. For us to add a new employee to our small group (less than 50 employees), we would make the request to Zenefits via their web portal. Simple? Not so fast. The new employee request must be routed from the Zenefits platform to BenefitFocus (a benefit administration platform contracted by Aetna) and then, ultimately transferred to Aetna.
Why does it work this way? Because many carriers still accept faxing, scanning or emailing as the only way to transmit health insurance documents. They are built on legacy systems and processes that desperately need an organizational and technological makeover. Though many carriers are switching to electronic data interchange (EDI) transmissions or machine to machine submissions, there will still be some left behind. Aetna, for instance, does not accept direct EDI enrollment files for small groups, perhaps because it is difficult for small groups to securely transmit their data in such a required format securely. To offer a workaround solution, Zenefits has two options to submit small group benefit changes to Aetna: changes can be submitted via the Aetna web portal manually or submitted via a slightly more automated access through BenefitFocus. It can take weeks before the submitter of the health insurance receives confirmation. These manual methods of transmitting information are time consuming and have a high probability of errors due to manual input.
Where the industry is going:
A federal mandate for benefits enrollment scheduled to be in effect by January 2016 states that the ACA “…establishes new requirements for administrative transactions that will improve the utility of the existing HIPAA transactions and reduce administrative costs.” Companies such as BenefitFocus, GroupHub, Zipari and FormFire are paving the way to help manage this data, improve benefit administration and streamline the file transfer process to ultimately:
- Cutting out third party administrators
- Eliminate paper and fax submissions
- Reduce administration costs
- Enable the consumer to manage their own information electronically
Where PokitDok comes in:
PokitDok’s X12 APIs follow the standard ASC X12 format, allowing businesses of any size access to essential health transactions, such as the 834 Benefit Enrollment and Maintenance file. PokitDok manages carrier connectivity, file validation, encryption and transmission in a secure and HIPAA compliant way. In addition, we have automated the file transfer process so files can be tracked along the way and we’re able to notify submitters when as soon as a response from the carrier is available. We also allow companies to connect and transmit benefit enrollment files to health insurance carriers without having to manually integrate with every carrier out there. That way benefit administrators can focus more on managing the benefits of their members and not the many business rules that are currently hampering the process.
It may be a slow move but with the federal mandate and consumer push towards healthcare price transparency and access, members will ultimately be able to win. 2016 will be a great year for healthcare technology companies as carriers prepare and continue to revamp their processes ultimately making updating your benefits a much smoother, easier process.
Tags: Dev, Health Innovation, Providers