Virtual Benefits Administrator
Real-Time Claims Payment

Authenticating and clearing insurance claims in real-time is most sought-after in the healthcare industry. Virtual Benefits Administrator (VBA) has enabled a watershed moment for insurance technology by launching the first cloud-based software and services platform for healthcare payments. VBA was also the first company to offer healthcare payer core administrative processing systems (CAPS) for real-time claims payment (RTCP). “We can adjudicate claims in real-time and pay a claim as and when we receive it electronically, so that a provider sees the payment in a matter of seconds,” mentions Tom Witter, president, VBA.

VBA’s core application and gateway have essentially put healthcare in the same league as e-commerce and retail, where people are used to having an engaging experience. Accordingly, the company has modeled VBA Application and VBAGateway using smart client technology to improve patient experiences at a reduced cost. Highly flexible, scalable, and user-friendly, the VBA Application offers advanced self-service, online enrollment, and reporting capabilities. VBAGateway is designed from the ground up using the latest web technology to focus on user engagement and provides round-the-clock access to the information sought by members, providers, employers, and agents/brokers. The dashboard enables uploading of EDI files, open enrollment, and claim submission, besides administrator-controlled gamification features to promote greater utilization.

To deploy its solutions, VBA adopts a non-linear approach wherein configuration of the software outweighs customization to meet the specific requirements of clients. The user-friendly application supports quick and efficient navigation through hyperlinks, which significantly reduces the overheads of time. The synergy unleashed by the VBA Application and VBA Gateway reduce inbound phone calls from members, providers, groups, and agents, allowing organizations to effectively reallocate internal staffing resources.

VBAGateway has proved to be an effective tool for generating new business and demonstrating the ease of accessibility and usability on-site for all stakeholders—members and HR departments—to improve customer service metrics, which effectively enhances a plan’s ability to secure larger group business. In one instance, a legacy claims system with excessive customization and limited scope for configurability to add more functions, posed technical challenges for J.P. Farley Corporation in on-boarding a large client in a timeframe of 90 days. When engaged to address the problem, VBA deployed its cloud-based administration software along with business and IT services that were extremely user-friendly and highly efficient for automating the processes to the extent of 90 percent. J.P. Farley Corporation was able to onboard their client easily and process efficiency was boosted by 50 percent, besides compliance with state CMS filing and encounter reporting.

In future, VBA plans to further improve its industry-leading RTCP capabilities through machine learning and AI. Witter mentions that VBAGateway will also witness continuous improvements based on the inputs from both VBA and non- VBA application clients. Witter also remarks that the technology currently available for healthcare providers and payers needs to advance with faster and efficient processes, while delivering real-time information when needed. He predicts that RTCP would receive a major boost with real-time health systems, where processes pertaining to insurance payments and claims would happen instantaneously. “We are in a very good position to assist organizations in taking on the forthcoming challenges in the real-time health system domain,” concludes Witter.