Payer Solutions

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• Direct Connections for real-time eligibility and coverage information

  Passport Health Communications Inc. has offered provider connectivity to real-time payer eligibility and benefit information since 1997. We primarily use HIPAA 270/271 technology but accommodate a variety of methods and sources that allow us to establish connections with more than 550 Insurers, TPAs, MCOs and general payers. Passport will work with payers to establish the payer’s preferred method of data transfer using a variety of communications protocols. Passport’s current network allows payers to connect with one out of every three hospitals, more than 5,000 providers and more than 80,000 active users across the U.S. 

• Outsourced EDI Solutions

  Passport’s software and services facilitates true Web-based electronic data transactions with providers in a secure, reliable and cost-effective environment.
  
  Acting as a partner and Business Associate with Health Plans, Passport services include:
  
  

  • Manage all EDI transactions with providers
  • Maintain all communication with submitters (providers and vendors)
  • Maintain both HIPAA-level edits and Plan business rules
  • Accept all submission formats, converting non-standard communication to fully compliant HIPAA transactions
  • Maintain all enrollment, testing and certification of electronic trading partners
  • Market, train and support providers identified by the Plan
  • Ensure leading-edge technology, transactions and processes are in place without the expense of internal development or resources

  
  Passport e-health services include:
  

  • Real-time eligibility verification
  • Electronic claims submission (benefit-level edits optional)
  • Electronic Remittance Advice
  • Claim Status
  • Referrals
  • Prior-Authorizations
  • Admission Notifications

  
  

  Passport’s goals in partnering with Health Plans are to increase EDI volumes, reduce administrative costs, improve claim payment process and meet HIPAA requirements. All may be achieved through implementation of Passport solutions.

• Provider Payment Cost Estimation (PPCE)

  Consumer-driven health care and specifically high deductible health plans has created a need for more intelligent information regarding the cost of health care services for both patients and providers.
  
  Through a combination of financial services, eligibility connectivity developed by Passport, contracting for claims and contract database services, Passport can design a PPCE solution to help members manage their out-of-pocket costs and address providers’ needs for timely collections.
  
  PPCE:
  Simplifies and improves payment processes
  Helps patients anticipate and manage health care costs
  Shortens the providers revenue cycle
  Reduces patient bad debt and the time and expense of patient collections
  
  PPCE can give providers and patients an understanding of the estimated patient payment obligation based on benefits status and fees for services to be provided. PPCE does not replace the claims adjudication process, but supplements the providers’ existing business processes with little to no change.
  
  A PPCE process presents the ability to provide a patient obligation estimator which will give providers and patients cost estimates that reflect the patient’s payment responsibility. This improves the adjudication process and assists services being reimbursed quickly and efficiently, reducing the time and expense of patient collections.

• Portal Services

  Passport can develop and maintain a “portal” for a single transaction that meets the needs of all providers, allowing payers to focus on tasks of health plan development, meeting government mandates and supporting core business operations. Passport provides a single entry point into the payer’s network offering industry leading provider support.
  
  Partnering with Passport for real-time 270/271 services is an attractive alternative to using internal resources that may serve the company more effectively in other areas.
  
  Contracting with Passport to maintain EDI responsibility for a multitude of inbound provider connections reduces the need for dedicated staff to answer telephone inquiries and eliminates the need for payers to offer providers a real-time eligibility verification system. As a Business Associate, Passport would be in a position to take in transactions from providers, and be responsible for all enrollment, testing, certification and security of new submitters attempting to retrieve information from the payer.
  
  Passport Portal Services include:

  • Support real-time eligibility provider activity
  • Register and set up providers
  • Support provider connectivity
  • Support provider use of application
  • Work with payer to define transaction(s) being supported.
  • Work with payer to create specifications to define transactions
  • Work with other vendors and providers for access to payer information
  • A single connection developed with payer to provide access to all providers in all states

• Call Center Analytics

  Passport will work with payers to research and analyze telephone calls from providers related to eligibility and benefit information.  We can determine the cause of inquires and assist the payer in reducing or eliminating these calls. Passport’s unique combination of extensive experience in provider office operations and insight with payer information allows us to develop and implement strategies that will significantly reduce internal payer expenses by reducing the number of phone calls from providers for eligibility and benefit information.