Sarah Joyce on January 7, 2016

Health Plan Portal Must-Haves for Collaborative Provider Networks in 2016

Sarah-Joyce.jpgThe arrival of the New Year means New Year resolutions and new goals for 2016. For health plans, improving provider satisfaction and productivity should be on that list, but what do provider networks need from health plans in 2016? User feedback is critical for the continued success of healthcare technology solutions. Yet, gaining user input can be more complicated than in other industries because the users of the technology aren’t necessarily the purchasers. For example, health plan or insurance portals are vetted, purchased, and designed by health insurance companies, but they are used by healthcare provider offices and organizations. Including these provider office end users in the design and improvements of a portal is critical so that the technology supports the provider office workflows and helps drive higher adoption.

Recent Provider Network Survey Results

NaviNetUserFeedbackMethods-1.pngThere are several methods that health plans can use to learn what provider network users want in their health plan portal. At NaviNet we use customer support interactions, workflow observation sessions, unsolicited on-portal product feedback, a user group advisory board, and regular surveys. This summer, we surveyed nearly 2,000 provider users to learn what they wanted from health plan portals.  Across the board, the survey showed that the number one thing users want is access to more health plans within a single portal. However, there were several other key user “wish list” items that health plans should consider when looking to choose, change, and / or improve their provider portals.  These wish list items centered around three functional areas:

  1. Eligibility and Benefits (E&B) Information
  2. Claims Management
  3. Provider Data

E&B Wish List

When accessing E&Bs, provider office portal users want flexibility and consistency in how they search within health plan portals. They also want complete benefits information and more details on benefits beyond what is provided in a standard 271, including:

  • Coverage start and end dates
  • More information for certain specialties (e.g., chiropractic, behavioral health, PT / OT, OBGYN)
  • Member ID cards
  • Additional PCP Info
  • External links to additional information or tools such as a payment estimator

To summarize, users want more of the information they need from the health plan portal without having to call the health plan.

Claims Management

Similar to E&Bs, users want more capabilities and functionality that will allow them to manage claims more efficiently within health plan portals. Provider office users want to be able to use health plan portals to:

  • Submit claims
  • Modify claims
  • Submit claim investigations
  • Resubmit denied claims

Consistent, Updated Provider Data

It should be no surprise that health plan portal users want provider data enhancements and up-to-date, consistent data. Health plan portals rely on the information provided by health plan customers, but data inconsistencies can exist within a specific plan’s provider data. These inconsistencies are magnified when the same user tries to do the same transaction for the same provider across multiple plan portals. For example, Jen is the office administrator for Dr. Mary White who contracts with several health plans. Yet, when Jen tries to find Dr. Mary White in health plan portal A, she is listed as Dr. M White, in health plan portal B she is listed as Mary White, MD, and so on. Dr. White is the same doctor regardless of the plans she contracts with, so why should she appear differently across the different plans’ transactions? This is frustrating for users like Jen. Consistent, accurate provider data, along with patient data is a key need for health plan portal users.

Heading into 2016

As you work to improve collaboration with your provider networks in 2016, keep in mind that your health plan’s portal shouldn’t just be designed for the needs of your health plan. Your providers have their own wish list that can actually be used to improve your portal, identify additional information providers need on a portal and reduce the number of times providers call health plans, which is on every plan’s wish list!

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Tags: health plans, Provider Portals

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NaviNet, part of NantHealth, is America’s largest interactive healthcare network. Our flagship multi-payer provider website is built on deep payer integration and the innovative use of technology to deliver real bottom-line value for both payers and providers.