Cutting costs through greater medical billing efficiency in the UK

A primary goal for us is to contain the business costs of health care, curb premium inflation and pass those cost savings on to our valued customers and members.

We’ll have one more way to do that starting shortly, when we begin working with Healthcode, a leading provider of IT services for the private healthcare sector focussing on industry solutions and the UK’s official digital clearinghouse for private medical bills.  Healthcode’s online bill submission and validation system makes the billing process easier for UK health care providers, while driving operational efficiencies that benefit our members.

Healthcode screens every invoice according to Aetna’s own criteria, including ones from specialists and treatment sites, for all diagnoses, consultations and procedures. Any queries or inconsistencies will result in the bill being automatically returned to the provider so that the query can be cleared up and the invoice resubmitted, when appropriate. This should lower overall claims volume by flagging superfluous or incorrect claims. That means we’ll receive clean, legitimate claims that can be processed faster and more efficiently — leading to quicker eligibility confirmations and reimbursements for our members.

Our Network Management team will continue to negotiate costs and business arrangements with providers. Determining eligibility and pre-authorisation requests for medical appropriateness will continue to be handled by our internal teams.

As we implement this arrangement, we’ll be looking at the potential to replicate it for key territories around the world. The more efficiencies we can drive, the easier it will be for providers to work with us — and the more our customers and members will benefit.

For more information, please contact your regional sales or account manager.

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