FAQ
- Details
What is eClaims?
This is a joint initiative by three of the key health insurers, Irish Life Health, laya healthcare and Vhi and is being co-ordinated by Insurance Ireland.
eClaims has been introduced as an industry standard so that claims can be submitted electronically in the same way to all private health insurers and to make paper claims a thing of the past.
What will the introduction of eClaiming achieve?
The aim is to rollout a national standard for electronic claims, which will benefit all parties, achieving savings through the reduction of paper work and providing healthcare providers with improved cashflow and resources to focus on patient care.
eClaims will ultimately mean faster submission of claims and faster payment with more control of the claims management processes.
What are the benefits of electronic claims filing?
Electronic claiming has many benefits not least the ability to quickly and efficiently exchange healthcare claims in the same way with the health insurers involved (Irish Life Health, laya healthcare & Vhi).
Its key benefits can be described as:
- Faster payment of claims / reduced debtor days
- Earlier detection of errors
- Lower operating costs
- Improved claims management processes
- Status & remittance to help understand the status of outstanding claims and payments
Has eClaims been implemented in any other countries?
eClaims is well established worldwide in countries such as the United States, Australia and the UK.
Why have the 3 insurers decided to come together on this specific initiative?
All parties recognise the need to phase out the current inefficient paper claims process in favour of electronic processing.
International best practice demonstrates that eClaims is the way forward, and it is imperative that the Irish healthcare industry develops its processes in line with these standards.
The aim of the project is to introduce an eClaims industry standard so that claims can be submitted electronically in the same way to all private health insurers and to make paper claims a thing of the past.
How were the pilot hospitals chosen?
The pilot hospitals were chosen in conjunction with the representative bodies for public and private hospitals (HSE and IHAI).
How will this initiative increase the speed with which claims are submitted?
There are 2 ways in which claims will be processed faster by:
- Reduction in administrative overhead: eClaims will facilitate the implementation and integration of hospital solutions which will remove the requirement for transcription/transfer of paper claims. This electronic method will make it easier for the consultant to review and submit claims. Client Management Systems will pre-populate information for consultants to sign off
- Availability of management information: managing electronic claims is faster and more productive than paper claims
Is the model remaining as straight-through processing from facilities to the insurers, or is a 3rd party being introduced?
No third party is being introduced to the process and the data flow will remain as before from the facility to the insurer. However healthcare providers will have to upgrade their claims management systems to move from a paper based to an electronic system.
Are you planning to rollout eClaims to the public hospitals?
The Multi Insurer Group (MIG) is ready to engage any public hospital to rollout eClaims
International best practice demonstrates that eClaims is the way forward, and it is imperative that the Irish healthcare industry develops its processes in line with these standards.
Does this link in with Universal Health Insurance?
eClaims is a critical enabler for Universal Health Insurance.
Under a Universal Health Insurance system, all facilities will be processing a much higher volume of claims - this is simply unachievable with the current paper system.
Future versions of the eClaims standard will accommodate the detail of UHI when published.
What are your rollout plans for eClaims?
The Multi Insurer Group has set a target to rollout eClaims by 2016 to the Irish healthcare industry.
Currently we are working with a number of key healthcare providers to rollout eClaims this year and will announce any new developments in this project as they arise.
Will facilities be charged a fee to submit claims electronically?
No, the insurers will not charge a fee for electronic claims submission.
Will Insurers continue to accept paper claims?
Yes, the insurers will continue to accept paper claims but eClaims by default will be processed faster. From 2016 onwards, it is likely that individual insurers may impose a fee to continue processing paper claims.
If there is a new entrant to the health insurance market will they be allowed join the Multi Insurer group?
At present the project involves three of the health insurers in the market however we are open to new additions joining this group at any point in the future.