Member portals reduce premium billing costs and improve on-time payment rates for health plans by moving invoice delivery, payment collection, and account management online. This eliminates check processing, reducing inbound billing calls, and giving members 24/7 self-service access. Certifi’s William™ platform includes a native member payment portal built on the Perfect Balance™ accounting architecture, with SSO integration, ACH and card payment support, retail cash options, and real-time billing data via API. In one implementation, William™ helped a client move from 100% paper and check payments to 62% electronic invoice delivery and 38% electronic payments in the first year. This cut transaction expenses by more than 50%.
Member portals have become essential tools for health insurance companies seeking to streamline premium billing and payment processes. Leveraging technology effectively is key to maximizing the benefits of member portals.
Here are four ways member portals streamline premium billing and payments:
1. Empowered Self-Service for Members
Member portals provide 24/7 access to billing information, payment history, and payment options, reducing reliance on phone calls and paper statements, thus empowering members to manage their accounts independently. From information about invoices and payments to the ability to set up payment accounts, member portals enable not only information gathering but also enable members to take action.
If you’re using a third-party insurance billing solution like Certifi, ensure it enables single-sign-on (SSO) and an API that enables you to grab important data – like invoice and payment data – to leverage in your internal portal. Doing so streamlines the member experience by not shuttling them between disjointed experiences.
Branding matters. Ensure your third-party payment portal matches your member portal brand so as not to confuse your members.
2. Reduced Administrative Burden and Costs
Automating billing and payment processes through portals minimizes manual tasks for insurance staff, leading to lower administrative costs, fewer errors, and improved efficiency in handling premium collections.
Your goal should be to maximize the electronic payments you receive. Managing a high percentage of checks increases admin costs. Electronic payments can be more easily applied to accounts while simplifying payment reconciliation.
Work to minimize check payments by encouraging automated ACH payments. One way to do so is to make it easy to set up payment methods like ACHs in your member portal. It’s also important to consistently communicate how to set up ACH payments. Leverage your member portal and invoices to communicate how to set up electronic payments.
3. Enhanced Payment Flexibility and Convenience
Offering diverse online payment methods (e.g., credit/debit cards, ACH transfers) through the portal improves member satisfaction and increases the likelihood of timely payments, reducing late premium and collection efforts.
Note, however, that the cost of many health insurance products likely prohibits the use of credit cards due to the processing fees. But for low dollar premiums – say those for CHIP or Medicare Advantage plans – offering multiple payment options may improve payment rates.
Another option for low monthly premium plans is retail cash pay. Populations with low dollar premiums are more likely to be underbanked and appreciate the opportunity to take an invoice into a local retail establishment, like Walgreens or Dollar General, to make a cash payment. William™ supports retail cash payment natively for health plans serving these populations.
Enabling cash pay for specific products or populations may increase payment rates because it offers an alternative to electronic payments. And, because all cash payments are electronically tracked and reported, it also streamlines the process for your staff.
4. Data-Driven Insights for Optimization
Don’t forget the importance of data. Member portal data provides valuable insights into payment patterns, preferred payment methods, and potential areas for improvement in the billing and collection process, enabling data-driven decisions to streamline operations and enhance the member experience.
For example, you may find that few members pay using a specific payment method – like credit cards – and the cost of offering that option may be more than it’s worth. You may also find that many members pay by check. Moving even a small percentage to ACH may save your staff time and eliminate manual processes.
William™ surfaces this data through out-of-the-box reporting, giving billing administrators visibility into payment method mix, delinquency rates by population, and collection trends over time.
Frequently Asked Questions
Q: How do member portals reduce premium billing costs for health plans?
Member portals reduce premium billing costs primarily by shifting invoice delivery and payment collection from paper and manual processes to electronic channels. Electronic invoice delivery eliminates print and postage costs. Online payment acceptance reduces check volume, cutting the labor required to manually match and apply payments. In one Certifi implementation, moving a population from 100% paper and check to 62% electronic invoice delivery and 38% electronic payments reduced transaction expenses by more than 50% in the first year.
Q: What payment methods should a health plan member portal support?
A health plan member portal should support ACH (bank account) payments, credit and debit card payments. For populations with low-dollar premiums such as Medicare Advantage and CHIP, health plans should considser retail cash payment. Retail cash pay allows members to take their invoice to a participating pharmacy or retail location (such as Walgreens or Dollar General) to make a cash payment that is electronically tracked and reported. Auto-pay enrollment should also be available to reduce reliance on member-initiated payments each cycle.
Q: How does a member payment portal improve on-time premium payment rates?
A member payment portal improves on-time payment rates by removing friction from the payment process. Members can pay anytime without calling member services, set up recurring ACH auto-pay, and receive electronic reminders tied to the billing cycle. Auto-pay has the highest individual impact because it eliminates the need for members to remember to pay each month. Offering multiple payment methods — including retail cash for underbanked populations — further expands the share of members who can pay conveniently.
Q: How should a third-party billing portal integrate with a health plan’s member portal?
A third-party billing portal should integrate with a health plan’s member portal via SSO (single sign-on) and API. SSO allows members to move between the plan portal and the billing portal without a separate login, creating a unified experience. API integration enables the health plan to pull real-time billing data — invoice history, payment status, amount due — directly into their own portal display. William™ by Certifi supports both integration methods and can be branded to match the health plan’s member portal.
Q: What billing self-service capabilities should a health plan member portal include?
A health plan member portal should give members the ability to: view current and historical invoices, see payment history and account status, make one-time payments via ACH or card, set up recurring auto-pay, update payment methods, and access correspondence such as delinquency notices. Providing these capabilities online reduces inbound billing calls to member services and empowers members to resolve billing questions independently at any time.
Q: What data insights can health plans get from member portal billing activity?
Member portal billing data gives health plans visibility into payment method mix (what percentage pay by ACH, card, check, or retail cash), electronic invoice adoption rates, delinquency rates by population or product line, and auto-pay enrollment trends. These insights help health plans make informed decisions — such as whether to continue supporting a payment method with low uptake, or where to focus member communication campaigns to shift more payments to lower-cost electronic channels.
Certifi’s health insurance billing and payment solutions help payers improve member satisfaction while reducing administrative costs.
