TLC Family Health Plan in Memphis Goes Paperless
With a Little Help from EMS
The Case for Electronic Remittances: Have you ever really analyzed the costs associated with generating paper checks and remittances for your network providers? In the case of the TLC Family Health Plan in Memphis, TN, that’s exactly what they did. TLC is a Medicaid Managed Care plan servicing Western Tennessee. TLC’s CFO charged his finance group with the task of quantifying the costs involved with producing its primary output – health care payments to providers. The basic material costs included paper, toner, pre-printed security check stock and envelopes. Alone, that represented a huge commitment of cash for the 2,000+ providers in the network on a weekly or biweekly check run. But when you factor in the operating costs such as the labor for printing, collating, envelope stuffing, mailing and follow-up, as well as the single largest cost – postage – the number approaches astronomical. And that doesn’t even address the less-identifiable costs like general overhead allocations, occupancy costs, opportunity costs of using staff in other capacities, etc. Any health plan needs to keep costs in check, but being an administrator of public programs, the need is even greater to keep efficient. As a long-time service provider to TLC, EMS was there to offer a solution.
The Plan: The solution EMS put forth to TLC was 3-pronged: (1) Save Money; (2) Give Better Service to the Providers; (3) Help the Environment.
(1) Saving Money: By piggy-backing off the existing HIPAA laws for electronic transaction sets, EMS began producing ANSI X12 835 Electronic Remittance Files for all of the network providers and made them available for download from the TLC secure web portal. After a grace period, the paper remittances were discontinued in favor of the downloadable file. Hand-in-hand, paper checks were also discontinued in favor of a direct deposit Electronic Funds Transfer (EFT). In one swift move, all of those costs (material, operating, and overhead) were gone!
(2) Giving Better Service to the Providers: But an electronic file is only useful if you can read it. If you have never seen an 835 remittance file, they look something like alphabet soup: The primary reason you don’t see health plans just “shutting off paper” in favor of E-remittances is precisely because there has not been a viable method for providers to read them.
EMS then converted this industry problem into an opportunity – EMS provided a proprietary software tool to decipher and manage the TLC electronic remittance files. This small but powerful tool was delivered by download at no cost to the TLC providers.
Providers can not only get their remittance information (and money) as much as 10 days sooner, through the use of the Reader software, they now have better information at their finger tips. Instead of paging through stacks of paper by hand, providers can now bring that data into an active grid right on their computer. They can filter, sort, find, arrange, and print results – in the manner they prefer. Providers can now manage claims faster, with less effort, and as much as 10 days sooner. The responses from providers has been fantastic.
(3) Helping the Environment: An attractive by-product of this whole process is that it is very eco-responsible. By shutting off paper reports, TLC is saving somewhere in the neighborhood of a million pages per year (that’s a lot of trees) and an unknown amount of fuel consumption from postal delivery.
In Closing….. The Plan has permanently cut out an enormous expense. Many thought it a risky move to “push” providers out of paper, but it went off without a single serious glitch. And the Providers are now so engaged in this process that if the ERA’s are even a couple hours late hitting the website, the customer service lines start ringing…..”where is my RA?” That’s a week to 10 days earlier than they are used to receiving them. As of this printing, nearly 500 providers are getting their remittances electronically in Western Tennessee, and the number is growing every day.
All Powered by EMS!
