Certifi to Deliver Improved Billing and Payment Management Through SaaS William Platform

By Michael Guta
TMCnet Contributing Writer

Inefficiencies in medical billing costs the U.S. healthcare industry billions of dollars annually, and as another government program, the Affordable Care Act (ACA) or Obamacare, gets integrated into the system that number is surely to rise. A study conducted by Harris Poll on behalf of NerdWallet in August of this year revealed hospital billing errors are resulting in overcharges of up to 26 percent. The number of errors for Medicare medical billing was all the way up to 49 percent, meaning almost one in two bills had some mistake on it.

While the ACA has many compliance regulations mandating the integration of information and communications technology (ICT) to make the healthcare system more efficient, the implementation has yet to bear fruit for the industry as a whole. But businesses are introducing solutions designed to solve different segments of healthcare, which is what Certifi, a software, services and consulting provider within the health benefits administration domain, has announced with the improvement of its software as a service (SaaS (News - Alert)) branded, William platform.

The company said it will be providing consolidated billing and payment management to the nation’s healthcare CO-Ops through a preferred vendor program. The William platform has been designed to manage the Health Insurance Exchange (HIX) back-office financial premium billing and payments, including brokering commissions and federal subsidy reconciliation and reporting needs.

The massive amount of waste taking place in medical billing errors is responsible for inefficient delivery of services to patients in the public and private sector. With hundreds of millions of transactions taking place monthly using multiple funding arrangements, it makes the medical billing process very complicated. The William solution is an information system built to scale to manage a wide range of funding arrangements for individual consumers, employers, health plans, brokers and service providers. Its accounting style transaction structure gives organizations a reliable and compliant financial recordkeeping platform even as the ACA brings in millions of new customers in a short amount of time.

Some of the benefits William offers include:

• Data management - it is designed to operate independently from a source eligibility system, and can use multiple sources of membership data or external transactions,
• Customized retroactivity rules – automatically apply sophisticated retroactivity rules that can vary by product or population,
• Rate flexibility – use virtually any rate structure based on membership, coverage level or volume, or easily add new rate calculations,
• Consolidated client invoice / remittance – generate consolidation of multiple benefit vendors into a single client invoice or remittance,
• User interface – utilizes latest user interface navigation such as “Google (News - Alert)”-style search function and the ability to bookmark a page and return later, and
• Fast track exchange builds – by 18-24 months by adding William as the financial engine to other plan selection and enrollment systems.

Although Obamacare will continue to chug along for the next two years even though the Congress will be controlled by the Republicans, there is no telling what will happen if the next President also belongs to the GOP. No matter what happens, the healthcare industry must continue to implement ICT to lower costs and improve services, and the Ceritifi William billing and management platform is one solution that will continue to introduce more efficiencies no matter who is in Washington.