New Remittance Advice streamlines billing process and win provider praise

As healthcare benefit consumers, we look to our Explanation of Benefits (EOB) to understand what our out-of-pocket costs will be when we’ve recently visited a medical provider.

Much like an EOB, providers in the EyeMed network look to their Remittance Advices (RA) to reconcile payments. An RA accompanies each payment EyeMed makes to a provider to summarize the payment and show exactly what claims and services are included in the disbursement. It’s a critical part of the billing process.

As you can imagine, building an RA that’s easy to understand isn’t an easy task. In fact, it’s no secret, EyeMed RAs have been a source of frustration for providers over the years. Simply put, through provider feedback we were able to glean that the current RA was not user-friendly and made it very difficult to reconcile their claims.

In the spirit of continually improving the way we do business with our network providers, we set out to make the RA easier and more useful for providers. After gathering provider input, along with requirements from changing regulations, we developed a new, cleaner RA that’s easier on the eye—and the results are amazing! It includes all the information a provider would ever need to reconcile their books. Take a peek—the format has exactly what providers need, when they need it. And when compared to the old format, the difference is eye-opening. See old RA (top) and new RA (bottom).

What are the key differences?

Chargebacks are the costs for materials or treatments supplied by network labs.

  • Simple calculations: We’ve organized the data in a way that corresponds to the calculations they need to reconcile payments with their books.
  • Timely access: Providers can access RAs the same day as payments are generated, rather than waiting 48 hours.
  • Clean format: Claims are organized by member name and date of service, so they can see everything about a claim grouped together in an easy-to-read summary—including detailed chargebacks by line.
  • Tools and resources: Definitions for terms and formulas are right on the RA, plus we created new tools for providers to get the information they need.

Onboarding providers to the new Remittance Advice

We worked hard to implement provider suggestions into a better billing experience, so we wanted to make sure we worked equally hard to let providers know how to read and understand the new RA. We launched a multi-faceted communication plan earlier this month, which includes several pre-launch emails, a new job aid, FAQs, several inFocus articles and post-launch emails that will go into each area of the new RA in greater detail. We think the providers will see what they want and love what they see!

Hear the buzz right here:

“The format of the new Remittance Advice is easier to read. I really like that it reflects the Total Claim Revenue as it allows you to see the total between what the patient paid and what EyeMed paid. I also like the Member Responsibility column as that helps me know that I have collected correctly from the patient. It also has the summary, remark codes and the RA detail terms on it for easy reference. Thanks, EyeMed, for making the changes and updating the Remittance Advice.”  ~Carol, GOC Vision

“I am excited for the new RA and I know my staff will find them much easier to understand when they are posting payments. The column explanations will simplify the posting process and hopefully go much quicker.” ~Holly, Mountain View Vision

Stephanie McCoy, manager, claims, was instrumental in the development of the new RA and is thrilled to finally reveal the new Remittance Advice. “As a result of stellar cross-functional partnerships, the new RA was designed with direct feedback from providers, is more aesthetically pleasing and easier to understand and reconcile.” Stephanie adds, “This has been a very exciting project to lead and I’m very thankful for everyone’s hard work. The end result is nothing short of amazing.”

Thanks to the cross-functional team who led the development and implementation of these changes, providers don’t need to have advanced degrees in math to reconcile their books. The new Remittance Advices are proving to be a game-changer for our provider network!

Print Friendly, PDF & Email