Solutions for Health Insurance Payers

Health insurance companies face a unique set of challenges when it comes to the receipt and disbursement of payments and remittance advice.  PNC Healthcare takes the time to understand your unique business requirements and information systems, and then offers technology solutions to help you become more efficient.

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Improve experience, reduce costs

Healthcare Matters Newsletter

Key takeaways about the financial aspects of healthcare 

Your existing processes of paying members via check is costly and often leads to unclaimed funds and escheatment hassles. Work with PNC to develop a better strategy for your consumer payments that electronically disburses payment to your members and allows them access to funds in near real-time. Payments can be distributed electronically via the Zelle network, reverse debit card, pre-loaded card, or check.

View ePayments Product Sheet »

Paying providers can be cumbersome based on the sheer number of National Provider IDs that you pay on a monthly basis.

HIPAA regulations also require that you meet specific requirements for Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) delivery. As a bank and a clearinghouse, PNC consolidates the delivery of the EFT and ERA, performs provider enrollment on your behalf, and offers customer service support for your providers through our CAQH CORE-certified Remittance Advantage product. PNC can also print and mail checks or card payments along with the explanations of payment to the provider.

View Remittance Advantage Product Sheet »

Healthcare regulations are constantly evolving and often create high volume, ad-hoc payment requirements that you need to fulfill.

Given the non-standard nature of MLR payments, it is imperative to have a partner that can meet your needs with short notice.  PNC’s payables solutions enable you to distribute these payments and unique remittance advice requirements in one comprehensive solution.

Each vendor is unique in terms of their relationship with you. It is essential to have all forms of payment (card, check, ACH, and wire) at your disposal and a financial institution that is well versed in advising you on when to pursue each type of payment. 

PNC adds value by integrating our Payables Advantage solution with both your claims system and AP system to enable a more automated approval and distribution of these payments.

Consumer Driven Healthcare

Tax-advantaged health spending accounts (CDH) are the perfect intersection between health and wealth management.

CDH accounts have become one of the nation’s fastest growing financial products. An intuitive, technologically advanced CDH solution that consolidates all account types in a single data base can help your individual membership and group employers improve efficiencies. It can also help improve your customer’s loyalty to your company.

When surrounded by actionable data and education for members, a truly advanced CDH solution will provide valuable insight into where your membership is spending their healthcare dollars, and can enable a rare revenue growth opportunity. As a strong, nationally regulated financial institution with deep healthcare expertise, PNC is uniquely positioned to serve you, your employer group customers and your members.

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Optimize Payment & Remittance Advice Delivery

As a health insurer, you need to efficiently make payments to many different healthcare providers, vendors, and your consumer membership all while adhering to strict regulations in the healthcare industry.

Increase electronic adoption of claim payment and remittance delivery

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Improve your member experience and reduce cost by electronically delivering claim, wellness credit, refund, and/or Medical Loss Ratio (MLR) payments

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Remove paper invoices from your process, efficiently match invoices to purchase orders, automate invoice routing/approval and expedite dispute resolution

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Optimize your working capital through a strategic approach to vendor payments

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Streamline Your Receivables

Automating your billing and receivables process is an important initiative with significant cost savings and customer satisfaction at stake. With more than 40% of our lockbox volume being related to healthcare transactions, we have a unique understanding of the payments you receive, and more importantly, the different types of exceptions that you encounter. PNC’s integrated, round-trip receivables solution enables you to efficiently bill, collect and apply your payments.

Go paperless with your billing

Your customers are demanding a more digital experience when they interact with you. One way that this can be accomplished is through electronic billing. Our integrated Print/Mail and electronic bill presentment solution enables your organization to provide this capability with one bill file to PNC and no required platform upgrades on your end. Your customers, both group and individual, will have the ability to elect to receive electronic statements through an online portal and automatically suppress future paper statements.

Allow your members to pay the way it’s convenient for them

Your membership is looking for convenience in terms of the way that they pay you. Each individual member or group customer views payments differently so it is important that you make all options available. At PNC, you can consolidate each form of payment from your customer base into a single accounts receivable file that fully reconciles to your bank reporting.

Accelerate the receipt of large payments from self-insured customers

Administrative Services Only (ASO) funding for claims can be a cumbersome process that can result in payment delays and ultimately overdrawn accounts. With PNC’s technology, you can set up an automated process that electronically bills your customer base and that automatically debits their account all while offering them flexible options to review and approve their payments.

Spend less time with non-premium payments

PNC understands that not every payment is standard. Our flexible AR Advantage platform enables unique data elements to be added to your received payments that will accelerate cash application.

Want more information on streamlining your receivables? Contact us to get started »

Competitive Liquidity Management Options

PNC’s liquidity management tools can help you improve the efficiency and velocity of short-term cash balances. You can minimize manual tasks while maximizing earnings and maintaining availability of funds.

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Find out how our expertise in Health Insurance can serve your organization's needs.

Brendan Borst
Health Insurance Group Manager
Treasury Management   |   215-585-4964

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