Background: All participating providers in an insurance network requires constant access to patient information to check Eligibility, receive Authorizations, submit Claims, view Explanation of Payment (EOP) and perform many other administrative functions. Insurance companies provides a self-service online portal as a tool to support their administrative needs. The web portal concept was developed to avoid high volume phone calls and being information being available at the providers leisure anytime of the day.
Problem: The biggest challenges are portal adoption, security, access control, training, redundant data storage and maintaining the operational cost. On the other hand, in the healthcare IT marketplace there are already universal provider portals, that manage security and access control, but at the cost of high maintenance or a per transaction cost.
Solution: At EIXSYS, we have developed a lightweight, role-based provider portal using the pre-built CORE Phase I and II certified “EIXSYS Gateway” for multiple Health Plans. The advantage gained here is a centralized data repository, data security, and low evelopment and maintenance cost with online help and training modules. This allows for provider offices to assign users bases on their roles to access verify member eligibility, submit claims and check their status, submit and confirm authorizations, view detailed patient panel roster, their medical records, gaps in care, and many other features and functionalities to engage the member with provider community specially with primary care provider.
Result: Providers are at ease, and the convenience of accessing pertinent information directly from their computer eliminates the need for lengthy phone calls. This portal allows providers to check claim status, verify eligibility, and access a patient’s medical record, patient medications, panel roster, view gaps in care, keep track of patient’s last date of visit, keep up to date with preventative testing, and improved health outcomes. Through our portal, data delivery increases member and provider collaboration.