Smart Routing Payment Service Offers Added Value to Enterprise Providers Resulting in Greater Savings for Payers

Adoption of electronic processing of claim payments and remittance data transmission has the potential to create real and impactful savings for commercial healthcare payers; however, healthcare providers must be willing to accept them first.

In order to facilitate greater adoption of electronic payments among providers, Zelis® Payments business unit continually develops value-added features for its product suite, which are designed to solve operational problems for providers. One new product enhancement that is gaining momentum is Smart Payment and Data Routing. Smart Routing was specifically developed for high-volume enterprise providers enrolled in Zelis’ VRA® (Virtual Reimbursement Account), an automated payment settlement and data delivery solution.

“Normally, when payments are delivered within large health enterprises, most payers send payment directly to the point of service,” explains Jase DuRard, Senior Vice President of Enterprise Provider Solutions for Zelis’ Payments business unit. “This often leaves these facilities with the arduous task of re-routing payment remittance data manually. This process could delay reconciliation or balance billing by as much as three weeks – and generally is an administrative headache.”

Smart Routing solves this problem by automating delivery to preferred delivery locations by TIN, NPI or a combination of TIN/NPI carve outs. This gives hospitals and health systems access to funds and data at correct locations within the organization, which speeds delivery and shortens the revenue cycle.

Zelis works closely with these provider clients to manage implementation of all TIN routing schemes. The Zelis team also conducts testing before launch and provides dedicated post-launch support services.

“The value of our Smart Routing service is two-fold: it creates additional value for our enterprise provider clients using VRA, which makes VRA an attractive and ‘stickier’ option for these high-value accounts,” said Jay Ver Hulst, President of Zelis’ Payments Business Unit. “This, in turn, helps to garner continued savings for our payer clients down the line as well.”

Within the last month, implementations have been completed at two health systems and six more installations are underway. These implementations represent 340,000 payments with multiple claims per payment – reducing paper production and delivery overhead for 125 payers that Zelis Payments represents.