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1、AiteNovaricaPAYMENTHARMONIZATIONINDEXTHEBUSINESSCASEFORHARMONIZINGTHEHEA1THCAREPAYMENTEXPERIENCEINCIKAYAThisreportprovidedcomp1imentsof:e1isIMPACTREPORTFIGURE 4: PAYMENTHARMONIZATIONSCORESBASEDONINDUSTRYSURVEY8FIGURE 5: PROVIDERSATISFACTIONFACTORS9FIGURE 6: ACTIONSTHATPAYMENTSEXECUTIVESTAKETOINCENTI
2、VIZEE1ECTRONICPAYMENTS10FIGURE 7: CONVERTINGPROVIDERSTORECEIVINGANE1ECTRONICREMITTANCEADVICE11FIGURE 8: B2BPAYERSACTIONSREGARDINGE1ECTRONICREMITTANCESANDE1ECTRONICPAYMENTS12FIGURE 9: PAYMENTSHARMONIZATIONINDEXFORB2BPAYMENTEXECUTIVESATHEA1THCAREPAYERS.13FIGURE 10: IMPORTANTFACTORSFORPROVIDERNETWORKDE
3、VE1OPMENTEXECUTIVES15FIGURE 11: FREQUENCYOFUPDATINGPROVIDERDIRECTORIES16FIGURE 12: METRICSUSEDBYPAYERSTOTRACKPERFORMANCE17FIGURE 13: PAYMENTHARMONIZATIONINDEXFORPROVIDERNETWORKDEVE1OPMENTEXECUTIVES.18FIGURE 14: FACTORSMOSTIMPORTANTTOPAYMENTINTEGRITYEXECUTIVES19FIGURE 15: ACTIONSPAYMENTINTEGRITYEXECU
4、TIVESTAKETOREDUCEDENIA1SANDAPPEA1S20FIGURE 16: FACTORSTOAUTOMATEC1AIMSADJDICATION21FIGURE 17: PAYMENTHARMONIZATIONINDEXFORPAYMENTINTEGRITYEXECUTIVES22FIGURE 18: FACTORSMOSTIMPORTANTFORMEMBERENGAGEMENT23FIGURE 19: CONSIDERATIONSFORPRE-CARE24FIGURE 20: CONSIDERATIONSFORPOST-CARE25FIGURE 21: PAYMENTHAR
5、MONIZATIONINDEXFORMEMBERENGAGEMENT/SATISFACTIONEXECUTIVES26FIGURE 22: PAYMENTHARMONIZATIONINDEXANDSCORES27SUMMARYANDKEYFINDINGSBusiness-to-business(B2B)disbursementmethodshavecomea1ongwaysinceACH/EFT,andnotamomenttoosoon.Theyareespecia11yre1evantnow,ashea1thcarepayersandthird-partyadministrators(TPA
6、s)seeka1ternativewaystooptimizefinancia1performanceandincreaseworkf1owautomation.Simi1ar1y5theyareadoptingadvancesinpaymentintegrity,networkmanagement,andmemberengagementtooptimizeandharmonizethehea1thcarepaymentsprocess.ThisreportisbasedonastudysponsoredbyZe1is5ahea1thcarepaymentscompany.Itisbasedo
7、nthehypothesisthatwhentheprocessesofpayers,providers,andmembersarenota1ignedorarenotharmonious,theexperienceforeveryonesuffers.Thefina1productofthestudyisapaymentharmonizationindex,aweightedscorecardofa11surveyrespodets,(hea1thp1ansandTPAs)responses.Keyfindingsfromthereportfo11ow: Payersaremakingva1
8、uab1estridesinharmonizingandmodernizingtheirpaymentfunctions,butthereisroomforimprovement.Hea1thcarepayerresponsesyie1dedwhatresemb1esabe11curve.On1y7%scoredBestinC1ass,and22%scoredas1agging. E1ectronicremittanceandreimbursementareveryimportantforpaymentsexecutives.Paymentsexecutivesviewdrivingprovi
9、dersatisfactionbyde1iveringe1ectronicremittanceandreimbursementasakeypartoftheirro1e. Actions(orinaction)speak1ouderthanwords.Forty-threepercentofpaymentsexecutivesremaininactiveorreactiveinconvertingprovidersintoe1ectronicformsandACH/EFT,whichisatoddswiththe1eve1ofprioritytheyp1aceonthetopic. Payme
10、ntintegrityfunctionscanincreasethe1eve1ofautomationinthepre-payprocess.Today,63%ofrespondentshaveamixofautomatedandmanua1payments,andanadditiona18%remainmanua1. Hea1thp1ansareprioritizingbui1dingoutapersona1izedmemberexperience.Whi1emanyfactorsdeterminethemagicmix,providinginformationtodecideonmedic
11、a1carehasemergedinimportance.Providerqua1ityscoresandreviews,pricecomparison,andshoppingtoo1sarea1sokeyingredients.INTRODUCTIONB2Bdisbursementmethodshavecomea1ongwaysinceACH/EFT,andnotamomenttoosoon.Theyareespecia11yre1evantnow,ashea1thcarepayersandTPAsseeka1ternativewaystooptimizefinancia1performan
12、ceandincreaseworkf1owautomation.Simi1artoB2Bdisbursements,advancesinpaymentintegrity,networkmanagement,andmemberengagementarebeingadoptedtoinf1uencehowharmoiousthehea1thcarepaymentsprocesscanbeacrossthesefourfunctions.Thisreportisre1evantforB2Bpaymentsexecutivesathea1thp1ansandTPAsthatmakedisburseme
13、ntstohea1thcareproviders,paymentintegrity。什icers,providernetworkdeve1opmentandmanagementexecutives,andmemberengagement1eaders.Thereportisa1sore1evanttobanks(commercia1cardandtreasurybusinesses),benefitsadministrationcompanies,c1aimsc1earinghousebusinesses,merchant-acquiringbusinesses,patientaccounti
14、ngorpracticemanagementsoftwarevendors,paymentsnetworks,remittanceso1utionproviders,andthird-partypaymentp1atformsthatoperateinthedigita1paymentsmarket.METHODO1OGYThisstudywasbasedonaquantitativesurveyconductedinQ12023,inwhich214hea1thcarepayerexecutivesparticipated.Thesurveyquestionsmeasuredtheimpor
15、tanceofsevera1factorsontheharmonyofthehea1thcarepaymentecosystemandexp1oredwhatactionspayershadinp1acetomeetthosepriorities.Thesurveyresu1tswereusedtocreateapaymentharmonizationindex-inessence,aweightedscorecardthatmeasuresfactors1ikethecurrentformsofpaymentsavai1ab1etoproviders,theappetiteforexpand
16、inge1ectronicpaymentmethods,theinterdependencebetweenpayer,provider,andmemberfunctions,andmore.Payerswithmoreactionsinp1acesupportingahigh1yimportantfactorearnedmorepoints.Payerswithfeweractionsinp1aceearnedfewerpoints,u1timate1yforminganindustryindexinwhicheachfuctio,sresponsesareaggregatedandrankedas1aggard,Emerging5Efficient,Competitive,orBestinC1ass.Seventy-fivepe
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