An Electronic Provider Reimbursement Solution 12/01/2010Confidential-All Rights Reserved-
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Transcript of An Electronic Provider Reimbursement Solution 12/01/2010Confidential-All Rights Reserved-
An Electronic Provider Reimbursement Solution
12/01/2010Confidential-All Rights Reserved-
Medical payment strategies being utilized by payers to lower fulfillment expenses
“Bulk mailing” of provider payments from print vendors 835s with paper EOB Direct provider payments Default and continue to process one check/one
provider claim
All with the objective to achieve a lower expense ratio…
Challenge - Expense Reduction
12/01/2010Confidential-All Rights Reserved-
A “Virtual” Provider Payment Option
Rete-Pay provides a virtual Provider reimbursement process that incorporates a prepaid payment card & “paperless” explanation of benefits
Also includes the targeted recruitment of highly utilized providers to adopt the electronic payment process
This approach delivers an innovative solution that immediately reduces administrative expenses related to printing paper checks, postage, and fulfillment expenses.
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Rete-Pay’s Innovative Solution
12/01/2010
Rete-Pay’s Payment Features
Providers can choose to receive payments via fax, email, an on-line portal or a permanent Rete-Pay card.
Payment Security – Includes the ability to “lock-down” the card to each Providers Existing Merchant Terminal
Easiest & fastest payment delivery option – no need to obtain provider banking information
Payments are linked to an On-Line Claims Management Portal for easy access, Reconciliation, Payment History,
and New Provider Enrollments.
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“Virtual” Payment Advantages
• 12/01/2010
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1.Provider submits Claim to Patient’s
Healthcare Carrier/TPA
7. Provider keys in Virtual Card Information into their Merchant Terminal to Complete Payment
Process
7. Provider keys in Virtual Card Information into their Merchant Terminal to Complete Payment
Process
6a. Provider Receives Payment Fax Containing Virtual Card Information
6a. Provider Receives Payment Fax Containing Virtual Card Information
6. Provider receives Payment Email and accesses Virtual
Card Information via Secure Link
6. Provider receives Payment Email and accesses Virtual
Card Information via Secure Link
2. Healthcare Carrier/TPA Sends Processed Claims /print file to RETE-PAY
2. Healthcare Carrier/TPA Sends Processed Claims /print file to RETE-PAY
3. Card Account is created for Each Provider to be Paid
3. Card Account is created for Each Provider to be Paid
4a. RETE-PAY sends extract file to append
provider email and fax
4a. RETE-PAY sends extract file to append
provider email and fax
4. Portal Subscriber? 4. Portal Subscriber? YES
5. RETE-PAY Sends email to Provider telling them their
Claim and Payment Information is
available online
5. RETE-PAY Sends email to Provider telling them their
Claim and Payment Information is
available online
NO
5a. RETE-PAY creates Fax Merge File Containing Claim and Provider Information , Card Number, CVV
5a. RETE-PAY creates Fax Merge File Containing Claim and Provider Information , Card Number, CVV
“Virtual” Payment Process
Rete-Pay’s “New Revenue” Opportunity: Generates a new revenue stream for the Payer Calculated off the monthly volume of medical claims
settled by Rete-Pay Continuous monthly payments for the life of the
contracted service agreement
“Shared Revenue” Opportunity Payer awarded 10 basis points $100 million in medical claim settlements through Rete-
Pay Annualized “shared revenue” payment of $100,000
New Revenue Stream
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New Revenue Stream Increased profitability through Rete-Pay’s Shared
Revenue Model Immediate Reduction in Fulfillment Expenses
By the dramatic reduction in print, postage, and fulfillment expenses from the first day of service
Improved internal efficiencies and provider office inquiries as providers utilize the self-service claims management portal
No implementation expenses or monthly service fees
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Carrier/TPA Benefits
New Revenue OpportunityClaims Processed Annually - $_________________*10 Basis Points (.1% )Revenue Opportunity - $_________________
Expense Savings OpportunityProvider Payments Processed Annually - #____________*Fulfillment Cost per Payment ($5.00)Savings Opportunity - $_____________
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Carrier/TPA Opportunity