It doesn't have to be this way ...

I don't know if this qualifies as an article, but it seems to be the only way to get more than a few lines into a single post here. And since the subject matter is article of extreme confusion and frustration, maybe that qualifies it as an Article?_____________________________________________

Dear health plans: Please consider this lament from a friendly but VERY frustrated provider group. Please simplify. In the process of getting set up with a new (to us) health plan, we are trying to make arrangements to be able to track our revenue cycle with them.

So far, from about 40 person-hours of inquiry

and internal discussion by our staff and signing up with multiple agencies subcontractor-agencies, here are some things we’ve learned:

·       There appear to be at least four different organizations involved in reviewing, approving, submitting for payment, approving payment and letting us know claims status for each claim we submit;

·       More often than not a call or email to any of them results in a “we’ll get back to you” automated reply. The “getting back” often takes days, weeks, or for eternity;

·       Almost as often as not, we receive contradictory information from two or more involved agencies about a single question or process. One does not seem to know exactly what role the other(s) is supposed to have in the process or who is the right player to approach with a question;

The results include a dramatically extended time frame before we can bill and receive payment properly, much wasted time, and hair-pulling perplexity.

It doesn’t have to be this way. Payers, please weigh in. Other providers, do you have similar or different experiences in this context? If we are truly focused on the Triple Aim, can we find a way to stop dropping a steel curtain over the target? Thank you.