PaySpan Health - Georgia Regional Fact Sheet

• Healthcare trends in the Georgia region: A new program has been launched in the state of Georgia with an aim to give individuals more options for their healthcare. Georgia Healthy Families is specifically designed for members of the Georgia Medicaid and PeachCare Kids programs and allows members unusual flexibility to choose from among three health plans and to choose a PCP (Primary Care Provider). The three health plans are Amerigroup Community Care, Wellcare, and Peach State Health Plan.
• Georgia is setting an example to the entire healthcare industry with innovative programs, and use of technology to drive change: Georgia Healthy Families is believed to be an innovative program, giving the rest of the country a benchmark to strive for. But the innovations in Georgia extend well beyond unique program design. Prominent health plans in the region are also setting trends through the use of new technology, in particular, technology to change the way that claims are settled.
• Background of EFT and ERA in particular region and how it has grown over the past months: Like most regions around the country, Georgia health plans were settling over 90% of their claims with paper checks and paper remittance advices. But two of the three Georgia Healthy Families plans have broken out of the old mold and are using a new service to transition to electronic claim settlement. The service, PaySpan Health from Payformance Health, is giving the two payers a practical way to offer Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) to their provider communities.In an industry that spends over $130B each year on administrative costs, these two Georgia payers are examples that things can be done differently – that processes can be changed to greatly reduce administrative expenses.
• Timing on when Payformance came into the Georgia region: The first of the two plans went live in October 2005, the second in March of 2006.
• Example of percentage of growth of EFT and ERA for one particular payer since implementation of the software: One of the two plans is believed to have been particularly aggressive in leveraging the PaySpan Health solution. Offering the new service to over 4,000 of their providers, this payer is believed to have been highly successful with adoption by their provider community. In just three months after going live, this payer has gone from settling zero claims electronically to settling 38% of claims with EFT!
• How it will impact payers and providers in the Georgia region: Payers who leverage PaySpan Health can expect to save between $0.23 and $0.42 per claim. While reducing payer costs, the service allows payers to increase services to providers. For providers, the service is free but the benefits are significant. Providers can expect to save between $1.15 and $2.94 per claim settled electronically. In addition, providers can avoid the manual re-keying of remittance data typical in the old paper environment.
• Payformance Health and PaySpan Health backgrounders: Payformance Health is believed to be the industry's most innovative provider of Electronic Funds Transfer and Electronic Remittance Advice solutions. Its flagship product, PaySpan Health, builds on the company's more than 20 years of experience in developing payment solutions. By automating the last phase of the healthcare claims process – payment and remittance – PaySpan Health optimizes funds transfer and remittance delivery and brings the promise of HIPAA administrative simplification to reality. Payformance Health is proud to be the Blue Cross and Blue Shield Association Preferred Partner for electronic payment and remittance advice services.

SOURCE: Payformance Corporation