Operational research in the health insurance industry call center context suggests that innovative, web-based, self-service provider portals may lead to increased efficiency. Efficiencies for the insurer are realized when health care providers have a diminished need to call the health insurance company call centers in order to submit a claim reconsideration. Health care providers are continually seeking ways to reduce their accounts receivable turnaround time in order to increase their revenue cycle cash flow. Additionally, within the back office, less phone time at the point of service may drive value. Recent industry trends, driven in part by the Patient Protection and Affordable Care Act (PPACA) suggest there is increased pressure on the part of both health care providers and health care insurers to reduce administrative costs.
Removing costs not directly related to patient care from the health care delivery system intuitively increases the likelihood of continued viability of the health related services and thus benefits society as a whole. The objective of this dissertation was to examine the influences impacting the adoption of a specific web-based, self-service tool in the context of health insurance provider portals. Supply-side influences included the potential for health insurance companies to reduce the number of inbound calls that would result absent web-based, self-service tools. In addition to supply-side influences, demand-side influences studied included reduced claim processing turnaround time that decreases revenue cycle time for the provider while increasing cash flow. Additionally, within the back office, less phone time at the point of service may drive value. Whether the type of provider influences call behavior as a result of web-based tool adoption was also explored. The types of providers are commonly characterized, within the health care industry, as hospital, physician and ancillary.
This dissertation begins to fill the research gap and extend understanding of key influences on web-based provider portal availability and use by assessing through a causal-comparative, quasi/experimental research design: 1) the results of web-based, provider portal claim submission process adoption on call-assisted claim submission process use behavior, 2) the difference in turnaround time between providers that use the newly available web-based claim submission process compared to the legacy call-assisted process, and 3) how the type of provider category impacts the continued use of the call-assisted process.
There are multiple contributions of this dissertation. These include providing a body of knowledge and research results supporting enhanced operational efficiency, by the reduction of calls, was derived through the development of web-based claim submission tools. By reducing calls a significant operational expense may be reduced. Web-based solutions for claim submission benefited both the health insurance company and the health care provider.
Health care providers experienced enhanced operational efficiency through reduced claim closure turnaround time upon adoption of web-based claim submission tools. In contrast, the hypothesis that the category of hospitals would abandon call-assisted claim submissions at a greater rate than ancillary and physician categories was not supported. However, all categories experienced a decrease in call-assisted claim submissions upon adoption of a web-based claim submission method. Specifically, this dissertation focused on reasons for health insurance companies to provide web-based, self-service provider portals for claim submission and why providers should use them.
|Advisor:||Kerr, Bernard J.|
|Commitee:||Alvarez, Raymond M., Ruroede, Kathleen J.|
|School:||Central Michigan University|
|Department:||DHA - Health Administration/School of Health Sciences|
|School Location:||United States -- Michigan|
|Source:||DAI-B 76/12(E), Dissertation Abstracts International|
|Subjects:||Web Studies, Health care management|
|Keywords:||Affordability, Call centers, Health care providers, Health insurance, Insurance claims, Web-based portals|
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