Remittance in healthcare explains a claim payment or multiple payments sent by an insurance payer to a provider. Remittance management software solutions streamline the entire lifecycle of processes surrounding the reception of claims, their payments, and the subsequent elaboration of the payments per health plan. Remittance processing software can automate parts of the workflow surrounding medical reimbursements and their subsequent remittances to help stakeholder organizations improve the speed and efficiency of payment processing. These solutions have come to form integral parts of medical administrative operations.
This is one of the primary benefits of any solution for managing healthcare workflows. Using healthcare remittance solutions introduces automation to the manual and repetitive activities that form an integral part of reimbursements. OSP can design solutions specific to the needs of individual organizations to enable them to leverage the advantages of automation. By minimizing human intervention, remittance software can boost the productivity of operations.
OSP can develop healthcare remittance delivery solutions to help accelerate the workflow of processing remittances for approved and denied claims. Unlike EOBs (Explanation of Benefits), using software for healthcare remittance management leverages the benefits of Electronic Remittance Advice (ERAs). These replace the need for physical paperwork with digital interfaces and eliminate the need for the overhead associated with physical documentation. Additionally, digitization also minimizes the chances of errors.
One of the biggest advantages of using a digital platform for remittance management is assessing data generated from day-to-day workflows. Providers can know about their revenue cycles by analyzing the data derived using remittance processing software and identifying where their organization is losing money. This insight enables them to take the necessary steps to change existing workflows and improve their revenue cycles.
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Remittance software is an application that manages funds transfer between companies or customers and organizations. Alternatively, it can be referred to as an electronic bill payment service that effectively improves any company’s revenue cycle. Healthcare remittance management solutions facilitate the complete range of processes from claims reception to payment received.
The remittance simply means transferring money from one party to another for the services rendered. Remittances play a major role in the financial ecosystem, especially for businesses. In healthcare, a remittance is a payment received by the provider from the payer. Healthcare providers requesting remittance must send payer 837 claim request documents with all necessary information about services they rendered. And the payer must also send 835 ERA documents with necessary information related to payments made for services rendered by the provider. This exchange is crucial for a successful remittance process.
This remittance process has multiple steps. It begins with the provider claiming monetary compensation from the insurance company by sending EDI, 837 claim request file. Then the payer will assess and verify the claim, and after weeks or months, they will send EOB or 835 ERA file. This electronic document has all the information related to the services the insurer is paying (EFT). Once the exchange of 837 and 835 is clear, the provider gets its remittance from the payer.
Healthcare remittance management software solutions development must ensure some essential features. However, it’s crucial to opt for the right developer who can effectively understand your requirements and tailor the software accordingly. Some must-have features in remittance software are centralized workflow management, optimized payment processing, seamless integrations with other systems, and data security.
Remittance processing refers to the automated system that handles all processes. Remittance processing software can automate processes like 837 claims submission, keep track of claims once sent, and update once 835 EFT is received. Remittance processing solutions can automatically process every task and save money and time. Moreover, these remittance processing solutions improve payment processing efficiency and minimize revenue loss.
The must-have qualities to look out for in remittance software are cloud-based and secured web portals, consolidated/centralized workflow management, automated payment processing, robust payment collection portals, seamless integrations with different health applications, and data security. With these qualities, healthcare remittance delivery solutions can improve the efficiency of workflows, facilitate automated data entry, minimize human errors, and cut down revenue loss.
Remittance management means handling claims processes until they are paid. That means healthcare providers deploy remittance management to electronically retrieve and process claims. Electronic remittance management reduces human errors and ensures a faster AR cycle. It even ensures the timely billing of secondary claims.
In a healthcare context, remittance is the process of insurance providers sending payments to the healthcare provider/hospital for services they rendered. For example- a man visits a hospital for chronic pain. His health plan provides him with full coverage. When he reaches the hospital, his insurance verification will be done, and after his consultation, the hospital will send an 837 claims request form to his insurance provider. This 837 claims request form will include all information about the man’s health plans and services rendered to him. On receiving this 837 claims request form, his insurance provider will assess and verify for errors and accuracy. Once that’s done, they will send 835 EFT details, and payment will be sent to the hospital directly. This process simplifies as a remittance.
There are four basic steps for efficient remittance management- Gather, Match, Go digital and Leverage data. Gather simply means collecting and organizing all remits and payments at one centralized location. This will ensure that all transactions are processed continuously through the same workflow. The next step, Match, means to verify the funds received as remittances with bank visibility and consolidate the unapplied and unposted remits at one central location. Also, automatically match payments and remits and prioritize re-association exceptions. Going digital means eliminating the manual process of remittance management. Leveraging data means using remit data to improve workflows. These steps improve the overall management process.
Remittance and payment are often used synonymously. However, there is a slight difference between both. Remittance specifically refers to the process of funds exchange between two parties for services rendered, mostly exchanged electronically. While payment also means a similar exchange of money for goods and services, in a healthcare context, remittance is preferred by providers and insurance companies.