HGI’s provides a real-time eligibility verification and claim adjudication platform for Limited Medical Benefit and Mini Med Plans significantly improving the experience of carriers, providers, and members in the healthcare reimbursement process.
As an end-to-end healthcare payment solution, it offers providers and members real-time information when it matters most – at the point of care. Utilizing a web-based portal, it captures and routes claims to provide real-time eligibility verification and claim adjudication for providers. By following the instructions on the back of the member ID card, providers can check eligibility before entering claims and view an adjudication summary that shows insurer and patient payment responsibility. Providers now have immediate access to reimbursement levels for the services they provide, receiving payment verification back through the portal while the member is still in the office.
Claims are re-priced to contracted network rates in realtime, and providers can sign up for Electronic Funds Transfer (EFT) to expedite payment. Providers that elect to receive reimbursement from the carrier via EFT are assured of payment within 48 – 72 hours.
HGI’s processing platform is convenient and secure, and plan members see the immediate benefit of the discount and their coverage, knowing at the time of service what their out-of-pocket costs will be. In addition, individual premium payment by credit card or direct debit from a member’s bank account can also be made available to members as an extension of this unique solution.
Integrated within a customizable enrollment interface, premiums may be collected for the first month as well as authorized by the member to occur on a recurring monthly basis thereafter.
HGI’s platform allows providers to instantly verify a member’s insurance status with a carrier prior to or at the point of care. This capability eliminates phone calls to carriers and reduces the number of rejected claims due to ineligibility.
Providers have three options of submitting claims electronically: through the portal, via EDI, or paper. Only claims submitted through the portal are adjudicated in real-time.
Contracted provider discounts are calculated and applied to claims in real-time upon claim submission. This ensures members receive the benefit of the negotiated discount prior to adjudication.
Claims submitted through the portal are adjudicated in real-time, detailing the member’s coverage, what the carrier will pay and what the member owes. An explanation of benefits generated in the portal can be printed and presented to the member before leaving the provider office.
HGI’s platform delivers electronic remittance and EFTs, eliminating paper checks and EOBs to reduce administrative and operational costs. ERAs are immediately posted to the portal and made available within the claim history report.
The HGI Advantage
- Eliminates provider and member frustration and confusion over plan benefits and what’s owed
- Streamlines payment at the point of care and helps members maximize available benefits
- Eliminates a paper-intensive reimbursement process for members
- Increases plan retention due to a better member experience
- Creates a more streamlined, cost-effective approach to reimbursing providers
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