NEW ROCHELLE, NY – The growth of consumerism, health savings accounts and self-paying patients is making real-time claims adjudication at the point of service increasingly critical to payers and their network providers.

The financial impact is acute, said Kenneth Willman, national director of provider interface at Humana. Speaking at a Corporate Research Group Web seminar titled Moving Ahead with Real-Time Claims Adjudication, Willman noted:

• Physicians only collect a small percentage of a patient’s responsibility after the patient leaves the office.
• Physicians spend more than $8 per patient to send out statements.
• Providers write off approximately 7 percent of their revenues to bad debt, according to a 2006 ARM Report.
• Many coinsurance plans ask that private pay balances are collected after the payer adjudicates the claim.

Humana’s 2005 research revealed that payer-developed real-time claims adjudication technology has to be integrated into a provider’s practice management system to avoid duplicated efforts and accept multiple payers.