Large Regional Health Plan Streamlines EFT/ERA Enrollment

November 2016

System-wide adoption of electronic funds transfer (EFT) and electronic remittance advice (ERA) has the potential to save the healthcare industry nearly $2.3 billion, according to the CAQH Index. While more than half of these transactions are now conducted electronically, greater adoption would enable health plans and healthcare providers to achieve greater administrative efficiencies and savings.

Under the Affordable Care Act, health plans are required to offer an electronic payment option to healthcare providers. While the move toward electronic payments has been steady, it has not gained as much momentum as other transactions, such as electronic claims submission, currently at 94 percent adoption.

Recognizing the value in making the EFT/ERA enrollment process easier for providers and seeking to encourage greater use of electronic payment options, one large, regional health plan worked with CAQH to explore how EnrollHub® could help them streamline their process. This CAQH Solution® enables providers to enroll in EFT and ERA with multiple health or dental plans at one time.

Prior to implementing EnrollHub, the health plan required all providers in their network to participate in EFT and ERA. However, providers enrolled by filling out a paper form and submitting it to the plan. These forms were often returned with errors or were difficult to read, and providers routinely contacted the health plan for assistance in filling them out, resulting in high administrative costs.

After conducting a cost analysis, the health plan determined that EnrollHub could increase the quality of their enrollment data and reduce errors through automation. The solution also enables providers to enroll with other health plans, which is an incentive for greater participation.

During the implementation phase, the health plan developed a method to integrate EnrollHub into their existing system to fully automate the enrollment process. Dividing the implementation into several stages, which included modifying internal IT systems and processes, the plan was able to eliminate almost all manual work associated with EFT/ERA enrollment.

The health plan also partnered with their provider education department to raise provider awareness of EnrollHub and how to sign up with the service. After implementation, provider enrollments in EFT/ERA increased nearly eight-fold, jumping from an average of 67 per month to 491 per month.

Plan staff no longer conduct calls to correct data errors and work solely in an electronic inventory tracking system to handle enrollments, reducing the department workload and freeing resources for other priorities. Because all enrollment data is now stored electronically, the paper filing system was eliminated.

Over the last two years, the plan has nearly reached its goal of moving all network providers to electronic EFT/ERA, gained numerous administrative efficiencies and eliminated a time-consuming and cumbersome process.

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