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White Paper
Improving Member Experience Through Payer Data Exchange
Summary
Many voluntary benefits in the healthcare ecosystem aren’t working as well as they should for members. Every year, about 40% of Flexible Spending Account holders forfeit part of their contributions. Discover how Payer Data Exchange offers a simple and secure way to request and access data held by multiple payers using a single point of access.
By: Matt Distel, Director of Product Management, Payer Data Exchange at Change Healthcare
Many voluntary benefits in the healthcare ecosystem aren’t working as well as they should for members:
- Only 37% of deductibles for High Deductible Health Plan (HDHP) policies are paid using pretax dollars from Health Savings Accounts1, 2
- Every year, about 40% of Flexible Spending Account holders forfeit part of their contributions3, 4
- Care advocates often don’t know that a member may need help until about three months after an episode of care begins5
- Obtaining a copy of a healthcare claim to support a voluntary insurance payment (e.g., for a short-term disability claim) can take anywhere from one to three months6
Many voluntary benefit providers need information from healthcare payers to support their core business processes. The challenge is that to obtain this data, they must ask their customers to supply it, establish individual data connections with multiple payers, or resort to unreliable screen-scraping solutions.
On the flip side, every payer must service requests from multiple benefit providers, which also requires building and maintaining multiple connections.
For both voluntary benefit providers and payers alike, this many-to-many arrangement is time-consuming and unnecessarily costly. And for members, this suboptimal data sharing means their voluntary benefits aren’t as effective as they could be.
Healthcare insurers and the voluntary benefit providers who need data from them would both benefit if they could make the fulfillment of data requests easier by maintaining just one connection and exchanging data using a standard format.
Improved data sharing helps voluntary benefit administrators, payers, and — ultimately — their mutual customers.
Seamless way to obtain information from multiple payers
Enter Change Healthcare’s Payer Data Exchange, a simple, integrated, secure, cloud-based way to request and access data held by multiple payers using a single point of access.
Payer Data Exchange solutions are tailored for HSA and FSA administrators, care advocates, and voluntary insurance carriers. Each will no longer need to maintain individual connections with multiple payers. These organizations can now serve their customers better and free up valuable resources to address higher priorities.
Payer Data Exchange acts as a nexus between payers and the businesses that need their data. Payers can make their data available via a single connection to Change Healthcare, and businesses that need that data can obtain it from the same source.
EOB Advisor for HSA and FSA administrators
EOB Advisor gathers Explanation of Benefits information from multiple payers and makes that data available to HSA and FSA administrators in a single format via a single API. With this data available, these spending-account administrators can improve not only their members’ experience in using their FSA or HSA accounts but also their overall financial health.
For example, FSA administrators can substantiate member expenses as they occur, eliminating the cumbersome need for customers to gather and submit supporting documentation. This improvement removes the biggest barrier to member reimbursement, thereby driving down FSA forfeiture rates.
By reconciling card transactions against information available through EOB Advisor, HSA administrators can detect when a member missed an opportunity to use pretax dollars to pay their medical bills.
From there, they can reach out to the member to offer a reimbursement from their HSA account or, if the provider hasn’t been paid yet, provide a convenient way to pay the bill using HSA funds. Driving HSA usage in this way increases tax savings for members, putting money back in their pockets.
Because eligibility checks typically happen before the member even visits a provider, this allows a care advocate to begin offering their assistance about three months earlier than they could if waiting for claim information
Pre-Care Alert for care advocates
Leveraging Change Healthcare’s unique position as a major healthcare clearinghouse, Pre-Care Alert monitors eligibility requests and responses between providers and payers for consenting members. It sends this information to care advocates, allowing them to help patients access the right care and make well-informed decisions. While care advocates must often wait for claim data to know their members need help, eligibility checks are the earliest electronic event in an episode of care.
Because eligibility checks typically happen before the member even visits a provider, this allows a care advocate to begin offering their assistance about three months earlier than they could if waiting for claim information. This early awareness makes it possible for a care advocate to guide members before they make healthcare decisions.
Claim Confirm for voluntary insurance carriers
Specialists at voluntary insurance carriers often need a copy of a healthcare claim to substantiate the details of a medical event before they can pay their benefit to a member. However, obtaining this information from a healthcare insurer through traditional means can take anywhere from one to three months, all while the member waits for payment of their voluntary insurance benefit.
Claim Confirm provides a single portal where specialists at the voluntary benefit insurer can make a request for healthcare claim information from any participating payer. The system returns matching claims either immediately or the next day, which the specialist can then use as supporting documentation in paying out the voluntary insurance benefit. The efficiencies Claim Confirm provides mean a specialist’s case needs to stay open for only a matter of days, resulting in much faster payments to members.
Get started with Payer Data Exchange
Depending on the solution, it may be possible for payers who are existing Change Healthcare customers to simply identify the data they would like to begin sharing with benefit providers. For other cases, or if the payer is not yet a Change Healthcare customer, a data feed can be established.
For benefit providers who need access to payer data, Change Healthcare can provide access to the appropriate APIs or portal. For some solutions, Change Healthcare also can establish a data feed.
Payer Data Exchange improves the lives of members by streamlining information sharing between payers and benefit providers.
Benefits of Payer Data Exchange
Payer Data Exchange improves the lives of members by streamlining information sharing between payers and benefit providers.
Members want to get the most from their voluntary benefits, allowing them to lead their most healthy lives not only medically but financially and emotionally as well. Members want and deserve:
- To increase their income by using pretax dollars from HSA or FSA accounts to pay their medical bills whenever possible, even if they at first forget these options are available to them
- Not to forfeit hard-earned dollars they have contributed to FSA accounts because they forget about them or if providing receipts is too burdensome
- To have their care advocates reach them as early as possible when they need help
- To have their voluntary insurance claims paid as quickly as possible
The more information shared between payers and voluntary benefit providers, the more member goals can be met. That’s challenging when each voluntary benefit provider must seek information individually from each payer – and each payer must service requests from multiple data seekers.
With Payer Data Exchange, this picture is simplified, allowing:
- Payers to provide data to a single location
- Voluntary benefit providers to access data from a single location in a single format
This offers value to payers and voluntary benefit providers alike:
- Faster time to implement
- Reduced expense due to having fewer connections to maintain
- Better customer experience
- Better patient outcomes
- Additional opportunity to earn transaction fees (for HSA/FSA vendors)
Thus, Payer Data Exchange offers advantages to both payers and voluntary benefit providers. And the improved information sharing between them made possible by Payer Data Exchange results in what should always be the highest goal: better medical and financial health in the lives of members.
Key Takeaways
- EOB Advisor helps gather EOB information for HSA and FSA administrators
- Precare Alert monitors eligibility requests for care advocates
- Claim Confirm helps supplementary Insurers get data from multiple payers
1 Kaiser Family Foundation Employer Health Benefits, 2021 Annual Survey.
2 Change Healthcare EOB Advisor customer estimation of average cumulative spend per HSA account
3 Workers Lose $3 Billion a Year in FSA Contributions (and Employers Get to Keep It), Money magazine, March 14, 2022.
4Employee Benefit Research Institute (EBRI). The Vital Statistics on Flexible Spending Accounts: Findings from the EBRI FSA Database. March 18, 2021.
5Change Healthcare Pre-Care Alert care navigator customer
6Change Healthcare Claim Confirm short-term disability customer
