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TPA Facilitates Claim Funding Workflows Online

claim funding interface on a desktop computer at an angle

Project Case Study

The Challenge

A Third-Party Administrator of self-funded plans struggled to manage the workflows of funding claim expenses incurred by plan members. While claim funding approvals were a critical part of the weekly business operations, it was heavy-laden with manual processes and disjointed technology.

Weekly requests for claim funding approvals were sent manually through secure email technology that required a separate login from the TPA’s portal. Accounting staff spent 8 – 10 hours a week creating customized emails for each employer, along with attaching the supporting documents with PHI. Tracking approvals and following up on outstanding requests required additional manual processes each week.

Determined to automate claim funding workflows, better protect PHI, and create an easier experience for all parties, this client went to Health Portal Solutions for help.

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Our Solution

HPS developed a claim funding module for the TPA’s web portal that would centralize the management of funding requests and employer approvals behind the same portal login.

With this solution, the TPA Accounting Department now configures and schedules email notifications that are automatically customized with the specific employer’s details. As the TPA posts claim funding requests, the portal automatically emails the employer requesting review and approval online. If the employer doesn’t respond, the portal automatically emails reminders every 1 – 5 days.

The Accounting Department receives daily reports of which employers approved the funding requests. The portal also keeps a permanent record of the approvals and the associated documentation.

The Results

By automating the sending of claim funding requests, reminders, and approval reports, this TPA achieved a 30% reduction in time spent on claim funding management. In addition, because claim funding management was consolidated into the TPA’s portal, this eliminated their time and costs of maintaining a separate secure email portal.

Through this enhanced technology, the TPA also provides better protection of PHI, compliance with timely payment requirements, and maintenance of provider discounts from timely claim payment.

Why HPS was the Best Choice

Health Portal Solutions specializes in consolidating Healthcare Payer workflows into one, seamless online platform, including Accounting processes. Our online tools are user-friendly, intuitive, and do not require technical expertise to use.

Because of the high degree of configurability, HPS’ solutions enable Accounting departments to customize workflows and communications in a way that minimizes manual intervention and saves time.

About Our Accounting Solutions

HPS makes Healthcare Payer web portals a one-stop shop for benefit management, including Accounting processes. From online invoices, to claim funding management, to online payments, the HPS portal helps Insurers and Third-Party Administrators manage and track important Accounting-related functions, all with one username and password. Read more.

HPS Client Success Story - Claim Funding

Download this Case Study as a PDF