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Gateway EDI
99 Percent Club: Rewarding Providers For Good Behavior
by Charlotte A. Martin
Reward systems for good behavior – a simple process that somehow always seems to work.
When a student works hard on a school project, he or she is often rewarded with that coveted “A.” When an employee achieves a new workplace milestone, an unexpected pay raise is always a welcome gesture. Or, finally, when a young child does something out of the ordinary, chances are good that a kiss from a parent or finally getting that so-desperately “needed” present, will go a long way to reinforce good behavior.
Valuing the power of positive reinforcement, Gateway EDI, a rapidly emerging EDI company based in St. Louis, has learned that rewarding its providers, too, for “good behavior,” results in overall reduced costs and enhanced administrative efficiency. Internally, Gateway EDI calls this new business strategy, the “99 Percent Club,” an innovative customer service orientation. This voluntary membership is open to any Gateway EDI provider, which will submit its claims in a specific format and timeframe that Gateway EDI establishes. If they meet these standards, Gateway EDI will commit to file their claims in as little as two days. As an obvious solution, and perhaps echoing where industry standards should be, there are few claims clearinghouses today willing to commit to or succeed in this quick turn-around process.
Instituting this strategy, however, did not happen by accident. Rather, it was driven by two factors: listening to the industry’s unhappiness over delayed claims, and Gateway EDI’s unrelenting commitment to customer service.
After results of a survey of business consultants, health care associations, providers, software vendors, and others, revealed extreme discontent about the status of rejected claims and associated costs, Gateway EDI suspected if these challenges could be resolved, its providers would be happier. Within months, it created the 99 Percent Club.
Here is how the 99 Percent Club works.
Any Gateway EDI provider that files claims in less than 15 days from the service date, produces more than 200 claims per month, and maintains an overall claim acceptance rate of 99 percent or better can become a 99 Percent Club member. In exchange, Gateway EDI will commit to file and produce faster claims payments (in as little as two days) which translates into quicker resolution of rejected claims, enhanced cash flow, and overall administrative efficiency.
Since formalizing the Club last June with 59 members (representing 60,000 claims, totaling $5.1 million), Gateway EDI recovered an estimated $230,000 in revenue from otherwise lost claims, eliminated $90,000 in resubmission costs, and decreased accounts receivable days by at least five days for Club members.
By first submitting 99 percent clean claims, Gateway EDI providers avoid the high cost of the average 30 percent rejected claims, half of which never get re-filed, but were stuck in the ‘claims black hole.’ Now, 99 Percent Club members report enhanced cash flow, cleaner claims, and equally as important, less time spent on administrative tasks and more on quality patient care.
Charlotte A. Martin is the President and Chief Operating Officer for Gateway EDI.
[PRINTER FRIENDLY VERSION]
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