Ventiv Technology

3 0 | 360º Aon eSolutions A growing number of insurers, third- party administrators and self-insured employers are looking into integrating their claims and bill review platforms. For a word that ought to be straight- forward; however, "integration" in the context of linking claims and bill review systems means different things to different people. Claims managers who understand the different levels of integration available to their organizations stand to reap the strongest return on the time, effort and resources spent on claims-bill review integration. To help with that understanding, this article identifies and outlines the basic levels of integration available in today's market. COMMONLY DEFINED "Integration" for most people means little more than timely processing of electronic data files exchanged by claims and bill review systems. For most people, integration also means built-in, automated acknowledgements and full error-handling. ≥ Aon 360º ExpERT VIEw America's next top model THE FULLY INTEGRATED CLAIMS-BILL REVIEW SOLUTION: THE THREE MODELS OF INTEGRATION 3] EMBEDDED SYSTEMS BUILT ON THE EMBEDDED MODEL DELIVER FULL-ACCESS INTEGRATION OF CLAIMS AND BILL-REVIEW SYSTEMS. IN THE EMBEDDED MODEL, CLAIMS EXAMINERS HAVE CONTROLLED, PERMISSIONS-DRIVEN ACCESS TO THE BILL REVIEW SYSTEM'S TRANSACTIONAL DATABASE. AS A RESULT, CLAIMS EXAMINERS CAN: » VIEW REAL-TIME STATUS UPDATES ABOUT THEIR BILLS » READ AND REPLY TO QUESTIONS FROM BILL REVIEW ANALYSTS » GET DIRECT ACCESS TO THE BILL REVIEW USER INTERFACE AND VIEW BILLS IN PROCESS OR PERFORM SPECIFIC BILL REVIEW TASKS » ACCESS THE BILL REVIEW PLATFORM'S REPORTING INTERFACE AND GENERATE STANDARD, CUSTOM AND AD- HOC REPORTS. BY CONTRAST, UNDER THE STANDARD AND WEB SERVICES MODELS, A CLAIMS EXAMINER WOULD TYPICALLY NOT HAVE ANY DIRECT ACCESS TO THE BILL REVIEW SYSTEM AND WOULD HAVE ONLY LIMITED INFORMATION PERTAINING TO BILLS IN PROCESS. 1] STANDARD THE DE FACTO STANDARD LEVEL OF INTEGRATION BRINGS CLAIMS AND BILL REVIEW SYSTEMS INTO SYNC AT THE END OF EACH DAY. BUILT ON THE BATCH-FILE TRANSMIS- SION MODEL, SUCH SYSTEMS: » SYNCHRONIZE MANUALLY OR BY SCHEDULE » SEND FROM THE CLAIMS SYSTEM: CLAIMANT, PROVIDER, PAYMENT RECORDS, ETC. » SEND FROM THE BILL REVIEW SYSTEM: POST-PAYMENT CHECK DATA, NEWLY RECEIVED BILLS, ETC. STANDARD INTEGRATION IS, ESSENTIALLY, DATA EXCHANGE THAT'S PERFORMED AFTER CLAIMS EXAMINERS AND BILL REVIEW ANALYSTS HAVE COMPLETED THEIR DAY'S WORK. BECAUSE THERE'S NO REAL-TIME SYNCHRONIZATION OF DATA, EMPLOYEES MUST SET ASIDE RECORDS FOR SPECIAL HANDLING—USUALLY THROUGH TIME-CONSUMING TELEPHONE CALLS AND/OR E-MAIL EXCHANGES. 2] WEB SERVICES THE MODEL KNOWN AS WEB-SERVICES INTEGRATION IMPROVES UPON THE STANDARD MODEL BY PROVIDING REAL-TIME UPDATES OF CERTAIN CLAIMS AND BILL REVIEW DATA ELEMENTS, INCLUDING: » CLAIMS EXAMINER'S VIEW OF A PARTICULAR BILL'S STATUS » BILL REVIEW ANALYST'S VIEW OF AVAILABLE RESERVE FOR A PARTICULAR CLAIM THIS IS AN IMPROVE- MENT OVER STANDARD INTEGRATION, BUT VALUE TO CUSTOMERS CAN BE LIMITED BY THE SOFTWARE VENDOR'S ABILITY TO SQUEEZE DATA ELEMENTS INTO TO A USER- INTERFACE SCREEN WITHOUT COMPROMISING USABILITY. ANOTHER LIMITING FACTOR IS THE VENDOR'S CAPACITY TO IDENTIFY, PRIORITIZE AND SCHEDULE THE NEW ADDITIONS OR CHANGES INTO FUTURE SOFTWARE RELEASES. FOR MORE INFORMATION, PLEASE VISIT WWW.AON-ESOLUTIONS.COM/INTEGRATED WHAT IT MEANS FOR YOU The embedded model solution truly is a great improvement over the standard integration model, going far beyond just the proper handling of scheduled nightly batch files. Embedded integration gives customers the power to choose best-of-breed claims and bill review platforms. It also gives claims examiners unfettered access to any area of either application allowed by the customer's security model. The takeaway? Bills get processed more quickly—with fewer mistakes—ultimately leading to even greater savings. 1 2 3 FULL ACCESS BILL STATUS CLAIMS DELIVERY REAL-TIME UPDATES REVIEW SYSTEM SYNCHRONIZE DAILY

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