THE HEALTH Service Executive (HSE) is to move towards the electronic processing of all health insurance claims following the success of a pilot project at St James’s Hospital.
The HSE estimates that the pilot, which involved the processing of claims from VHI patients, reduced administration costs by at least 20 per cent and halved the time that the hospital was waiting for payment from the insurer.
From last month all insurance claims involving VHI patients at the hospital are being processed electronically. For two years prior to that, selected claims were processed electronically on an experimental basis.
Throughout the rest of the health service, all patient claims, ranging from hospital accommodation to consultants’ bills, have still to be collated manually at the hospital and submitted to the insurer. On average, seven different forms are used in just one insurance claim. The process can take six months from the treatment to the hospital being paid and at any time it is estimated that there is about €100 million owed by health insurers to hospitals.
The HSE is now preparing tender documentation to implement a similar solution nationwide in the nation’s hospitals and they will be issued around the end of next month. The first hospitals to implement the new arrangement are likely to do so three months after that.
The HSE is currently grappling with an unprecedented reduction of €1.1 billion in its budget this year and sees the processing of electronic claims as a relatively pain-free and efficient way to save money.
HSE assistant national director of finance Kieran Madden said hospitals like St James’s employ five people full-time working on insurance claims and the electronic processing of such claims would free up hundreds of staff across the State to work on wards. He stressed there would be no redundancies as a result of the changeover.
The pilot project at St James’s involved Claimsure, a software program developed by Sláinte Technologies which is based at the Guinness Enterprise Centre near St James’s Hospital. “We’re very satisfied that it works. We’ve seen the evidence that since it was implemented, the cashflow from these claims has almost doubled and it has reduced the time the hospital is waiting to get paid from six months to three months,” Mr Madden said.
The HSE has listed the move from a manual paper process to an electronic submission protocol as a “target milestone” which should be rolled out across the system to realise major reductions in administrative and financing costs.
The HSE has stressed it had no preferred bidder in advance of issuing the tender.
However, Sláinte Technologies chief executive and founder Andrew Murphy said the company, which currently employs 29 people, is hoping to take on 20 more staff in the next two years. It won a David Manley Emerging Entrepreneur Award last year.
“Obviously we are proud of the Claimsure solution, which is not just the technology but the process that it underpins,” Mr Murphy said. “We will continue to invest heavily in new product development and so we hope closer collaboration with insurers and clients will reduce transaction costs further across the industry.” He said it was the ultimate aim of the Claimsure process to get the payment of claims down to 45 days.
