2 min read

Secondary payer claims – finding ROI (Reducing Outstanding Income)

By Prime Care Tech Marketing on Fri, Apr 08, 2016 @ 03:27 PM

iStock_000062942648_Small.jpgIn a recent blog, we highlighted some benefits of automating secondary claims processing through a clearinghouse. The ROI is potentially huge.

Traditionally billers completed paper forms and mailed them to the payer. Sounds simple, but it wasn’t and, some providers are still submitting claims in this way. Phone calls and error-generated resubmittals contribute to a complex, cumbersome, costly, and prolonged payment process. With electronic claims preparation and submittal, providers can securely submit and track claims to multiple payers all in one portal. Here are some of the advantages a claims clearinghouse can offer:

  • Single location electronic claims management with real-time electronic claims verifications
  • Smooth claims flow to payers with a significantly reduced risk of rejections - since claims clearinghouses are connected to multiple payers and understand the peculiar format and workflow requirements
  • Electronic Remittance Advice (ERA) –view all payments and adjustments
  • Claim Status Reports
  • Rejection analysis in which the system explains error codes in English
  • Edit and correct claims online anytime
  • Real-time support

ROI - Secondary claims process saves time

Think of time savings in two ways:

  1. Billers’ time – The manual workflow of copying, mailing, and filing claims takes time. Even hand keying claims to each payer takes time. Billers have to know the specific submission requirements of each payer. In a manually-generated claims environment, such complexities can result in errors and slower claims turnaround. With a clearinghouse, such as primeCLAIMS, the system prepares the secondary claims automatically. All billers have to do is review the claims in the Secondary tab and click on the button to send them. It’s simple. And our customers love using it. The ROI? A reduction in claims processing and related costs.
  1. Claims turnaround time - Office Managers can go right to the Secondary payer tab once they have downloaded the 835 ERAs (Electronic Remittance Advices). The secondary claims are there for review and submission. No delays. And the claims are accurate and prepared automatically to meet payer-specific requirements the first time. The ROI? A reduction of 4-6 weeks in claims turnaround and payment. One of our customers has stated that it has had a major impact on the reduction of Days Sales Outstanding (DSO).

To give you an idea of what’s at risk, if you are not using a clearinghouse to submit secondary payer claims, take a look at our Secondary Claims ROI calculator and see for yourself. The calculator helps you to identify what revenue may be at risk as well as the time and money it takes to manually generate the claims.

Are you collecting all your secondary claims and how much does it cost to do so?

Check it out.

Topics: clearinghouse ROI electronic claims secondary claims secondary payer
1 min read

Procurement – What’s in it for me, the Buyer? (Part II)

By Rusty Zosel on Thu, Aug 25, 2011 @ 09:00 AM

istock_000002069044xsmall-resized-600What is the ROI? Last time, I highlighted some of the features of the fully-automated procurement process. As attractive as the various features sound, the real synergy occurs when Buyers experience real savings. In today’s sluggish economy, in general, and because of dramatically contracting reimbursements for health care providers, specifically, ROI must be real and attainable.

Ultimately, what really matters is savings - applied (or realized) savings. Let’s look at numbers to illustrate the potential automated procurement ROI. The following hypothetical example illustrates the savings that a 2,000-unit multi-location operation could experience. Let’s assume that this Buyer purchases about $10 million in goods and services  - $7 million from large Vendors for food, medical supplies, maintenance, housekeeping,  office supplies, therapy services, durable medical equipment, etc., and $3 million for purchases of all types from smaller vendors. The savings illustrated in the model below are the direct result of the following automated procurement process features:

  • An automated order & invoice transaction process
  • An automated process for handling invoice-only transactions
  • An automated process for handling manual purchase orders

ROI Model*



*Estimates are conservative and based on extensive research. You may contact me for more information and detail on Savings Analysis. 


While the above example is hypothetical, our experience and research indicate that positive results are achievable. In these uncertain times, providers have to be able to count on realizing the savings built into their procurement contracts and experience additional savings through utilization of today’s technologies. That is how the fittest will survive.

Because the highest level of eProcurement is a “Patronizing Partnership,” where both Buyers and Vendors mutually benefit, the next blog will address the benefits Vendors experience through procurement automation.

Topics: automated order process automated invoice processing manual purchase orders invoice-only transactions ROI real savings automated procurement process realized savings
2 min read

eProcurement – What is it? What’s in it for the Buyer? (Part I)

By Rusty Zosel on Thu, Aug 11, 2011 @ 09:30 AM


iStock_000001263418XSmall-resized-600In past blogs I’ve referred to Patronizing Partnership as the highest level of eProcurement Evolution, a Buyer/Vendor relationship marked by trust, cooperation, and mutual support. Let’s discuss this in more practical terms which go beyond the platitudes and attitudes, first by defining what is eProcurement Evolution, specifically, complete procurement automation. (In Part II, I’ll illustrate the benefits of eProcurement with a plausible ROI scenario.)

The Automated Procurement Process – removing the barriers to communication

Let’s start with that which lies at the heart of eProcurement Evolution – open communication between Buyers and Vendors facilitated by the automated procurement process. What are the essential features of a fully-functioning automated procurement process?

The automated procurement process essentially is comprised of the following three elements:

  • A user interface to support configuration of custom business rules, vendor management, and item management
  • An automated exchange of transactions with vendors and buyer systems
  • Application logic to check all configuration and business rules against vendor transactions and buyer systems

For the user of Procurement Partners, transaction automation embraces:

  • A customer-specific and customized application access point for all users
  • A corporate access point for enterprise customers, enabling corporate staff to view procurement activity at all levels of the organization from the corporate level to the individual facility
  • Order approval workflow and tracking
  • Electronic Transactions: purchase orders, acknowledgements, confirmations, updates and invoices
  • Contract and item maintenance with vendors

Automated exchange of transactions with vendor and buyer systems insures an open two-way conversation, including:

  • An online communication protocol with vendors and service providers
  • Custom integration into vendor order processing and item database systems and buyer ERP/accounting systems using their best practices
  • Transaction processing with update/change notifications
  • Electronic invoicing for all types of invoices
  • Invoice approval workflow and tracking
  • Contract price and freight reconciliation
  • Custom alerts at multiple steps in the procurement process

Application logic is the “secret sauce” that really makes procurement automation work.  Here are a few of the ingredients:

  • Customized business logic
  • A vendor product catalog with content maintenance capability
  • Contracted item maintenance, analysis, and reporting
  • Enterprise user administration and management
  • Price reconciliation for contracted items
  • General ledger structure, assignment, and processing support
  • Budget support, tracking, and alerts
  • Intelligent reporting


The two major benefits that Buyers experience from a fully-automated procurement system include:

  • Improved contract compliance – getting the consistent value and price they negotiated with their Vendors.
  • A tangible ROI – leveraging the contract compliance process for real savings. This is what I’ll address in the next blog

Question: What features would you like to see in a fully-automated procurement process?

Topics: order approval workflow business commerce evolution eProcurement ROI automated procurement process partnership


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