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Banks & HSAs 5/15 BS&T Banks are beginning to eye opportunities in the healthcare space beyond offering HSAs. 5/3 & JPMorganChase are among the financial institutions rolling out services for their healthcare clients - including doctors, hospitals & insurance companies - aimed at expediting payments & cutting paper out of the claims process. ‘Banks have the financial wherewithal to help providers get paid faster,’ says Nav Ranajee, 5/3. ‘3b transactions flow through the healthcare industry. That’s why banks are so interested in this market. HIPAA was designed to create efficiencies for the healthcare system. Providers still are very paper-based.’ Ranajee notes that the 835 Electronic Remittance Advice (ERA) format was created to allow insurance companies & healthcare providers to exchange claims & payments information electronically. Because HIPAA only provides guidelines, insurers have created disparate 835 forms, resulting in a nightmare for providers as they try to decipher each company’s requirements. ‘HIPAA was designed to drive paper out of the system,’ adds Alberto Casas, JPMorganChase, whose HealthcareLink automates the claims reimbursement process for healthcare providers. ‘The 835 electronic standard is highly underpenetrated, & it’s not standardized. The payers receive an electronic claim from a doctor - that part is 90% electronic. But the insurance company then takes that electronic information & 70% of the remittance advices they send back to providers are paper EOBs. Adoption of electronic payments here is even less; the payment element is 85% paper checks.’ 5/3’s Web-based ERA Integration service removes the burden of interpreting 835s from healthcare providers, according to the bank’s Ranajee, who explains that by reconciling the 835 data files & ACH payments transactions, the bank is able to normalize the data. ‘Our ERA Integration service takes the 835s from the payers i.e., insurance companies, customizes the information & matches it with the remittance advice. We do this as a single point of contact, & all data is automatically posted online. Healthcare providers can access our portal to view this information. It creates a lot of efficiencies for them.’ ERA Integration is designed to provide healthcare clients with a single, manageable data file that enables automated posting. ‘Clients receive a single view of their information from us. Our healthcare clients struggle to pay for hardware & software. But since we’re a Web-based, ASP application service provider solution, they don’t have to worry about installation & maintenance of the system.’ JPMorganChase’s Casas notes that while insurance companies recognize the benefits of paperless transactions, they often lack the resources to enroll providers to receive electronic payments. The bank hopes to ‘leverage our relationships on the provider & payer sides to accomplish this. We are reaching out to payers directly on behalf of our provider clients to enroll the providers to receive EFTs & 835s.’ Although 5/3 & JPMorganChase bring considerable electronic information delivery & payments know-how to the table, neither believes it has the healthcare expertise to clean up the claims payments process alone. Both banks have tapped healthcare technology providers to support their services. 5/3 has partnered with Oklahoma City-based RMS, a medical payment & remittance system provider, & claims reimbursement technology provider GHN-Online. JPMorgan acquired FisaCure, a provider of electronic remittance services, & partnered with RelayHealth, a clearinghouse for healthcare transaction information. ‘With the rails they established to connect providers & payers, along with our payment, claim-capture & reconciliation capabilities, there is a huge opportunity to drive efficiencies in the system. But banks can’t do this by themselves.’