Metavante In The Middle: A Gateway To Healthcare Electronic Data And Payment Interchange

Health plans who are Metavante clients report that, with traditional eligibility systems in place, 60 percent of incoming calls are from providers seeking eligibility information and verification. Another 25 percent of calls are related to claim status inquiries from providers. These tasks, including initiating paper check payments and paying for postage, have been traditionally inefficient and expensive ones for payers and providers, thus driving up the cost of healthcare.  Healthcare Gateway marries healthcare information and payments together to facilitate more efficient provider-to-payer communication processes that ultimately can improve payer-provider relationships and increase health plan member satisfaction with both groups. Key functionality includes real-time eligibility verification, electronic claim submission to health plans, claim and payment status monitoring through an online interface, electronic remittance advice with post-adjudicated claims payments processing, explanation of benefits distribution, plus acquiring and processing of Metavante benefits card payments. While submitting claims electronically isn’t a new concept, Metavante’s ability to link real-time eligibility information with claims submissions and re-associate post-adjudicated claims payments through a single online gateway represents a new day for healthcare electronic data and payment interchange. With re-association of post-adjudicated claims payments, providers will know which claim they’ve been paid for, which claims have been denied, and which parts of a claim have been denied and why.Metavante establishes the payer-provider connections, manages the flow of eligibility and claims information, processes post-adjudicated payments through automated clearinghouse (ACH) and re-associates the payments to their original claims. Both payers and providers have online dashboard login access to Healthcare Gateway, which can receive information from any payer. Providers can use their Healthcare Gateway online interface to get the eligibility, claims and payment tracking information they desire, electronically and in one place. These real-time information status updates, when combined with a greater payer-to-provider electronic payment volume and re-association of claims payments, can accelerate providers’ cash flow and lead to reduced operational costs for both payers and providers. Providers concerned about increased collections responsibilities in a consumer-directed healthcare environment can also look to Healthcare Gateway for assistance. By enabling real-time eligibility, deductible and co-pay verification for each and every office visit, the gateway can help a provider determine exactly what a patient owes in some scenarios. Additionally, providers can connect a card reader to their computer, accessing the gateway to accept payment from a Metavante benefits card, for example, before the patient leaves the office. The card reader also enables providers to initiate eligibility, claims and payment activities with the swipe of a magnetic stripe-equipped eligibility or combination eligibility and payment card. Metavante Healthcare Payment Solutions is helping transform the healthcare payments industry by accelerating the exchange of information and funds between patients, payers, providers and financial institutions. Forging new connections between payment and data systems to quicken the claims process, Metavante expedites benefits eligibility verification, claims substantiation, medical remittance processing, and payment and explanation of benefit distribution. With Web-enabled tools, an HSA platform, multi-purse benefit debit cards and combination eligibility/payment cards, Metavante enables integrated consumer benefit account management of HSA, FSA, HRA, and dependent care and transportation accounts.