Payment Reconciliation

HPAC payment reconciliation addresses the challenges and complications of balancing transactions while reconciling claims, remittances and payments by leveraging the platform’s ability to convert paper payments into transactional data and integrate multiple data sets of electronic transactions into a sophisticated reporting and reconciliation functionality.

Today, most claims are submitted to payers as EDI 837 files via PMS/HIS systems and scrubbed at claims clearinghouses. Industry-wide, nearly 50% of the remits and payments are still generated as paper. Besides the overhead of manual posting remittance and payment data into the PMS/HIS, multiple payment channels adds complexity to reconciliation.

Even if specific providers have converted to 80 or 90 percent electronic remittances and payments, reconciliation can become a challenging exercise to reconcile the following scenarios:

  • Electronic claims (837) to electronic remittances (835) and EFT payments (ACH)
  • Electronic claims (837) to electronic remittances (835) and paper payments (check-only)
  • Electronic claims (837) to paper remittances (EOB) and paper payments (check)
  • Electronic claims (837) to paper remittances (EOB) and EFT payments (ACH)

HPAC streamlines this process to deliver the following achievements:

  • Reduces reconciliation time via automated matching and reporting
  • Identifies errors and misbalanced payments
  • Improves research process with archive of transaction data and images
  • Provide full payment picture from claim creation, insurance remittance to patient payments
  • Reduce receivables and revenue leakage
  • Reduces suspense account entries
  • Improves denials management
  • Ability to close our monthly and quarterly financial reporting faster and more accurately

Testimonial


“Although the balancing and reconciliation objectives are the same across providers, the complexity to manage multiple payment types can be addressed within the HPAC solution.”

- Roni Boker
Director of Product Management, Healthcare Solutions 

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