Major provider groups and health care systems participating in the Humana Preferred (BHCG) network agree to the development of action plans focused on cost reduction through efficiency and quality of care improvements. Since its inception, the BHCG has engaged numerous network provider groups in the development and implementation of these provider action plans. One such action plan resulted in efficiencies gained by a network provider group – efficiencies that allowed them to help control their costs.

ProHealth Care Medical Associates was faced with a problem. Checks for reimbursement of medical services would arrive from Humana via the U.S. mail. After depositing them, one person would spend one to two days manually posting the payments to individual patient accounts. The process was laborious and time consuming.

ProHealth Care Medical Associates approached the BHCG and Humana within the context of the provider action plan process looking for a solution for the inefficiencies caused by this manual process. After several meetings, it was determined that ProHealth Care Medical Associates could benefit substantially from receiving an electronic file containing the electronic remittance advice. When ProHealth Care Medical Associates initiated the EDI 835 process, a form of electronic remittance advice processing, their world changed. What used to take staff days to post now took literally minutes.

“We are impressed with the initiative the Business Health Care Group (BHCG) and Humana displayed to help ProHealth Care Medical Associates streamline our clinic operations. BHCG’s provider action plan process promotes accountability among health care stakeholders and allows us to work together to find solutions,” said Clyde (Bud) Chumbley, MD, President & CEO of ProHealth Care Medical Associates.

“The action plan process helped us develop the ability to electronically post payments to individual patient accounts within minutes, eliminating a manual process that took us one to two days to complete. The efficiencies we have gained bring more value to the health care services we provide and allow us to control our costs,” added Dr. Chumbley.

This provider action plan provides a powerful example of what can be accomplished when payers and providers – with intervention and support from the BHCG – come together to positively impact inefficiencies in our health care system. We all benefit from this type of productive collaboration.

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