Pareo workflows minimize duplicate requests, enable quick and secure sending/sharing, and support request detail to allow for information to be exchanged in a HIPAA-compliant manner. The discreet and accurate advantage that Pareo gives to the medical record requests is more straightforward than manual processes. Providing relevant information and making it easy to comply with requests creates a prime avenue to boost provider NPS.
3. Full claim denials
Many times, a health plan will deny an entire claim when only a line item or two are incorrect because their systems are inflexible. The inability for said systems to be dynamic and responsive is a big detractor when it comes to provider NPS.
For one, denials are very costly to providers. The process is hardly straightforward and despite both providers and payers being frustrated by denied claims, it is the provider who is at risk for not getting paid. This alone can create undue stress and added tension, which may boil over at technology inefficiencies. Health plans and payers are entering into a more symbiotic relationship, and more can be done to improve the workflow of claims denials.
“A study by the Medical Group Management Association found the cost to rework a denied claim is approximately $25, and more than 50 percent of denied claims are never reworked.”
Pareo gives health plans the capability to deny claims at the claim line level to avoid the costly back-and-forth with providers. It also surfaces supporting documentation to validate these findings without page-by-page review. Part of a broader value involving analytics and ROI, our technology solution streamlines the claims process to reduce costs and improve efficiencies for both auditors and providers. By addressing claims denials at a granular level, a provider can more accurately correct information where needed.
4. Outdated provider outreach
In almost all areas of our lives, modern electronic communication rules the day. Not so with the payer-provider relationship. The current process at most health plans relies on manual activities that lack context. Fax, mail and endless phone trees appear custom designed to result in communication breakdowns. No wonder more than 30% of providers report not communicating with payers at all.
Pareo supports provider education and detailed explanations for transparent communication and real-time feedback. No more vague letters and submitting the same type of denial over and over again. Pareo provides a “log” of communications between providers and payers that can prove vital in clearing up issues.
Pareo’s payer-provider portal easily and securely combines claims, related medical records requests, communications records, underpayment and overpayment reporting, and other necessary information. Two-way communication engenders trust and creates a path for collaboration that will prove vital to broader goals.
Data Visibility Makes the Difference in Provider NPS
Providers understand the importance of claims payment accuracy. But those efforts don’t have to result in ill-informed, ill-timed communications that damage this valuable relationship. To that end, we built Pareo with transparency top of mind. Uniting multiple health plan stakeholders – services vendors, internal staff and providers – on a single technology platform leads to efficiencies and shared insights you can’t achieve otherwise.