As we begin a new year with hope, the healthcare industry is faced with the most challenging of times due to COVID19. While some sectors such as hospitality and tourism saw setbacks, many industries such as online retail, online grocery shopping, entertainment, and gaming flourished amid the pandemic.

Traditionally, the healthcare industry hasn’t been so quick to adopt technology compared to others. However, there have been pockets of adoption for improving quality of care and saving physicians’ time through remote monitoring and telehealth systems. The truth is, the resurgence of digital in healthcare has never been more prominent than now.

In this blog, I will discuss how it’s time that healthcare payment providers looked to digital to solve some of the critical issues boggling the industry today.

Untapped potential

The truth is, many healthcare providers today consider it fortunate if they can collect even 50-70 percent of what’s owed to them. Even if the payers pay on time, the shortfall from patient responsibility amounts can have a bearing on their bottom-line, and how profitable they can be.

Of course, providers have to focus on care and cannot be pushed to focus on receivables. This is why it’s time for providers and payers to consider digital payments.

Let’s get some basics straight – Electronic payments such as an EFT (Electronic Fund Transfer) is a payment method where the beneficiary (provider of healthcare service) receives the funds to his/her account directly from the payer, along with the ERA (Electronic Remittance Advice). The ERA is an explanation from a health plan to a provider about a claim payment. It contains information on how a health plan has adjusted claim charges based on the member’s plan. Since there is no snail mail involved, it takes less than a day for the provider to receive the money.

Payments streamlined and simplified

Electronic payments are the only solution to this problem, and healthcare payments providers can make this journey easy for everyone – patients, providers, and payers. When patients receive electronic bills, they can see what the responsibility amount is (as explained in EOB or Explanation of Benefits), get easy payment options, and complete the cycle quickly and easily. The providers also receive the payments due to them quickly and the EOP or Explanation of Payments statements electronically.

Enabling digital payments

As you can see, electronic payments have multiple advantages. However, for healthcare payments organizations, legacy systems can be a hindrance in enabling electronic payments. Understanding the EFT/ ERA Rules and CAQH Core compliance can be a daunting task against the backdrop of strict service-level agreements and penalties.  Furthermore, if payment providers need the ability to generate and send patient statements electronically, the system should be able to correctly reconcile the ERAs, providing accurate information about patient responsibility balances.

These are good reasons why payment providers should work with a technology partner who is familiar with handling EDI. Integrating payment systems with billing systems requires proven expertise and will ensure that the solution has a high adoption rate. Even with all these challenges, working with a technology partner who has expertise in streamlining the electronic payments process can make the journey quick and painless for payment providers.

Please write to us at to discuss how to adopt methodologies to ensure seamless integration while enhancing the digital payments processes.

With inputs from Umakanth M, Project Lead, IT Services


  • Bhupesh Nadkarni brings with him over 20 years of rich experience in IT services industry with expertise in Healthcare and Manufacturing domains.

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