Metavante's New Healthcare Gateway

Health plans who are Metavante clients report that, with traditional eligibility systems in place, 60 percent of incoming calls are from providers seeking eligibility information and verification. Another 25 percent of calls are related to claim status inquiries from providers. These tasks, including initiating paper check payments and paying for postage, have been traditionally inefficient and expensive ones for payers and providers, thus driving up the cost of healthcare.

Healthcare Gateway marries healthcare information and payments together to facilitate more efficient provider-to-payer communication processes that ultimately can improve payer-provider relationships and increase health plan member satisfaction with both groups. Key functionality includes real-time eligibility verification, electronic claim submission to health plans, claim and payment status monitoring through an online interface, electronic remittance advice with post-adjudicated claims payments processing, explanation of benefits distribution, plus acquiring and processing of Metavante benefits card payments.

While submitting claims electronically isn’t a new concept, Metavante’s ability to link real-time eligibility information with claims submissions and re-associate post-adjudicated claims payments through a single online gateway represents a new day for healthcare electronic data and payment interchange. With re-association of post-adjudicated claims payments, providers will know which claim they’ve been paid for, which claims have been denied, and which parts of a claim have been denied and why.

“Existing practice management solutions have been limited in electronic claims submissions capabilities and account reconciliation functionality. These tools have moved slowly to develop efficient electronic claims and eligibility connections between payers and providers, and many have priced small and mid-size providers out of the market,” said John Reynolds, president, Metavante Healthcare Payment Solutions.

Metavante establishes the payer-provider connections, manages the flow of eligibility and claims information, processes post-adjudicated payments through automated clearinghouse (ACH) and re-associates the payments to their original claims. Both payers and providers have online dashboard login access to Healthcare Gateway, which can receive information from any payer.

“Healthcare electronic data and payment interchange adoption can only increase across the industry when eligibility, claims, payment activities and related tools are all available as a suite,” continued Reynolds. “Tools that work together, like those coming together to create Healthcare Gateway, can finally entice providers and payers to move beyond paper-based legacy systems.”

Providers can use their Healthcare Gateway online interface to get the eligibility, claims and payment tracking information they desire, electronically and in one place. These real-time information status updates, when combined with a greater payer-to-provider electronic payment volume and re-association of claims payments, can accelerate providers’ cash flow and lead to reduced operational costs for both payers and providers.

Providers concerned about increased collections responsibilities in a consumer-directed healthcare environment can also look to Healthcare Gateway for assistance. By enabling real-time eligibility, deductible and co-pay verification for each and every office visit, the gateway can help a provider determine exactly what a patient owes in some scenarios. Additionally, providers can connect a card reader to their computer, accessing the gateway to accept payment from a Metavante benefits card, for example, before the patient leaves the office. The card reader also enables providers to initiate eligibility, claims and payment activities with the swipe of a magnetic stripe-equipped eligibility or combination eligibility and payment card.

Added Reynolds, “Healthcare Gateway fulfills the financial cycle for a provider, from the time a patient walks in the door until the provider has been paid and the payment has been posted. Additionally, the gateway provides the infrastructure necessary to tap the true potential of combination healthcare eligibility and payment cards, because eligibility claims and payment info flows through the same gateway.”