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Competitive Health was the first and the only company to provide an automated patient payment responsibility and network information real-time solution to the healthcare marketplace.
Utilizing multi-media this solution includes facsimile, IVR, VRU, Internet and XML technology, Competitive Health's solution is currently being utilized in over 400,000 physician locations nationwide.
Patients, Providers and Payors benefit immeasurably with access to patient pay responsibility at the time of service. Competitive Health is the only point of service solution in the country that communicates to the provider's office; patient eligibility, PPO patient responsibility, connect to a debit card platform, transmit the claim data real-time, and faxes back to the provider an explanation of savings/benefits.
The ability to know the net PPO patient responsibility at the time of service and communicate this net amount to a debit/stored value card, is a critical component in the healthcare marketplace. The advent of increasing patient pay programs such as, high deductible, limited benefit plan design, Health Savings Accounts, Health Reimbursement Accounts insurance programs require the provider know what the "net" patient responsibility is at the time of service. Competitive Health's system is the only national system that has been deployed in provider's office for over 5 years. Over 1.5 million physician transactions have been processed utilizing this real-time solution.
- Provider Advantage
Providers today write off over $100 billion dollars. This will only increase with high deductible programs. The ability to secure payment from the patient at the time of service will dramatically enhance the provider value proposition. Providers must be able to secure payment in this new patient pay environment.
- Patient Advantage
Patients who have access to our point of system enjoy the PPO contracted rate at the time of service. Today the patient is told by their healthcare program to not use their healthcare debit card at the provider's office. The ability to determine the net PPO patient responsibility allows the patient to use their medical debit card at the time of service, thereby eliminating the need to file a paper claim.
- Payor Advantage
Payors who want their high deductible, indemnity program, limited benefit plan design, Health Savings Accounts, Health Reimbursement Account subscribers to enjoy PPO contracted rates can now provide savings to patients and payment to providers at the time of service. Maintaining the provider value proposition is critical in the new patient pay marketplace.
- Indemnity Plans
Indemnity, mini-medical programs and scheduled benefit programs can now offer their insureds access to PPO contracted rates. Because our service reprices the PPO visit at the provider's office the carrier does not have to load PPO networks in their claims system. Their process of adjudicating the claim does not change. However, the carrier benefits dramatically by increasing retention of their book of business. Insureds who have to pay substantially less out of their pocket stay on the books longer, which can mean millions of dollars to carriers. Again, the key difference is our program provides insureds PPO network rates at the time of service.
- High Deductible/HSA/HRA
With the increase in popularity with high deductible programs, one of the outstanding issues is how to pay the physician their "net" contracted rate at the time of service. Our automated system that already exists in every licensed physician office in the country can determine patient eligibility, reprice the appropriate PPO contracted rate, and fax back to the provider two copies of the explanation of benefits. In addition, all the data can be transmitted to a stored value card/debit card that can be utilized at the time of service. The patient can then pay the provider the "net" amount at the time of service.
- Patient wins
When our technology is utilized the patient wins because they are able to receive the net PPO contracted rate at the time of service. This benefit is critical to the success of a program. If the provider charges the patient the gross billed charge for the visit, the patient cannot put the difference between the gross billed charge and the contracted rate back into their HSA/HRA account. Patients with indemnity programs benefit tremendously because the scheduled benefit from the carrier will cover a much higher percentage of the patient charges for their visit to the physician or the hospital.
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