Electronic Claims Settlement (ECS): Automated Processing for Healthcare Providers

PayStream Research Spotlight: Q3 2011

Overview

PayStream Advisors is developing a vendor analysis and buyer’s guide for healthcare providers who are seeking information regarding automated payment processing for the management of healthcare claims payments.  Electronic Claims Settlement (ECS) services are defined as the payment and remittance processing services offered by transaction processors and banks, which eliminate the inefficiencies of paper check and remittance processes through the automation of payments from healthcare payers (insurers) to providers. Recently, a new breed of settlement and remittance management solutions has emerged to automate claims payments. This report is focused on the growing numbers of healthcare providers that wish to shift payment processes to an electronic environment, accelerate information exchange and increase visibility and control over claims payment transactions.

The forthcoming report will provide valuable insights into emerging trends in the settlement of healthcare payments.  As part of PayStream Healthcare’s Technology Automation series, this report is designed to help healthcare providers leverage the use of advanced networks and processing services to optimize the claims payment and remittance reconciliation process. This report will focus exclusively on solution providers that deliver services for the processing of claims, including initiation and posting of payments and conversion of EOB’s and EOR’s to Electronic Remittance Advices (ERA’s).

The ECS Buyer’s Guide is written for healthcare providers who desire to bring cost savings and innovation to their organization’s payment and collection practices without disrupting their current business processes. This 50-60 page report, which will be published in the third quarter of 2011, is intended to help claims, treasury, PFS, billing, collections and IT managers make vendor and technology selection decisions as they evaluate new options to optimize their claims payment processes. This report will focus on solution providers who have strong capabilities and product strategies to meet the needs of healthcare providers for claims payments.

The preceding partner report Electronic Claims Remittance (ECR) will focus more specifically on the needs of medical insurers and third-party payer organizations.

Audience

Healthcare Providers

Accounts receivables, remittance and collections, and revenue cycle managers interested in improving the efficiency of claims payment and remittance processing operations by reducing paper-based processes. These managers may be interested in automating the cash posting process with post-able Electronic Remittance Advices (ERAs) and electronic storage of the remittance detail.

Objective

The primary objective of this report is to increase healthcare finance, revenue cycle, and IT managers’ understanding of Electronic Claims Settlement services and the benefits that they offer.  The report will also provide a critical update of PayStream Advisor’s vendor/solution research library.  PayStream’s library is a valued source of vendor information for hundreds of billing, finance and treasury professionals who are seeking information on potential technology solutions to support their automation efforts.  Our report represents an opportunity for solution providers to present their capabilities and points of competitive differentiation, and enhance PayStream Advisors’ ability to effectively counsel clients on the benefits and strengths of their solution.

Scope

The report will review vendors in the Electronic Payment and Electronic Claims Settlement industry (as shown in Figure A) who have developed a targeted product portfolio for claims payment automation. Figure A represents a map of the key features that ECS vendors offer as part of their products/services.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PayStream Advisors will market the report through both proprietary and third party channels. After a press release, at the time of publication, the report will be promoted through PayStream’s website, trade conferences, and speaking appearances at events. PayStream’s analysts will also be submitting report abstracts for article publication in trade publications. The full report will be distributed free-of-charge to registered users of PayStream’s Research Portal, and at speaking engagements, prospect and client visits, and industry conferences.

PayStream Advisors will also host several ECS Web seminars during Q3—Q4 2011. These instructional seminars will assist finance managers in the education process and will include an overview of the benefits of ECS solutions, as well as several case studies of ECS in use at providers.

Industry Talk

• AP Matters Magazine: Is healthcare paperwork almost extinct?

A recent article examines how the increasing adoption of electronic remittance advices (ERA's) is leading to the elimination of healthcare paperwork. 

Key Terms

Electronic Claims Settlement (ECS)

The payment and remittance processing services offered by transaction processors and banks, which eliminate the inefficiencies of paper check and remittance processes through the automation of payments from healthcare payers (insurers) to providers.

Electronic Remittance Advices (ERA's)

A replacement for paper explanation of benefits documents, an ERA is an electronic communication from health plans to healthcare providers that contains claims payment information. ERAs were designed to allow for the electronic posting of payments to an accounts receivable system without human intervention: ERAs provide details about claims payments as well as notice of a payment due to the provider via electronic data interchange (EDI).

Sponsorship Opportunities

Are you interested in participating in this report? For more information regarding sponsorship opportunities, please contact:

Mark Colwell, Solutions Specialist, 704-405-5983

 

About PayStream Research

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