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An Electronic Provider Reimbursement Solution 12/01/2010Confidential-All Rights Reserved-

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Presentation on theme: "An Electronic Provider Reimbursement Solution 12/01/2010Confidential-All Rights Reserved-"— Presentation transcript:

1 An Electronic Provider Reimbursement Solution 12/01/2010Confidential-All Rights Reserved-

2 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… 12/01/2010Confidential-All Rights Reserved-

3 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. Confidential-All Rights Reserved-12/01/2010

4 Rete-Pays 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. Confidential-All Rights Reserved- 12/01/2010

5 11/3/2010Confidential-All Rights Reserved-1 1.Provider submits Claim to Patients Healthcare Carrier/TPA 7. Provider keys in Virtual Card Information into their Merchant Terminal to Complete Payment Process 6a. Provider Receives Payment Fax Containing Virtual Card Information 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 3. Card Account is created for Each Provider to be Paid 4a. RETE-PAY sends extract file to append provider email and fax 4. Portal Subscriber? YES 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 Virtual Payment Process

6 Rete-Pays 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 12/01/2010Confidential-All Rights Reserved-

7 New Revenue Stream Increased profitability through Rete-Pays 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 12/01/2010Confidential-All Rights Reserved-

8 New Revenue Opportunity Claims Processed Annually - $_________________ *10 Basis Points (.1% ) Revenue Opportunity - $_________________ Expense Savings Opportunity Provider Payments Processed Annually - #____________ *Fulfillment Cost per Payment ($5.00) Savings Opportunity - $_____________ 12/01/2010Confidential-All Rights Reserved-

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