The Power of Separate Enrollment and Billing Software for Health Plans

In 2022, Adobe, a software giant known for its creative and marketing tools, offered to buy Figma, a company known for its web-based user interface (UI) and user experience (UX) design tools, for $20 billion. Though the deal eventually failed because of regulatory concerns, it highlighted how purchasing bundled software products may not be the best choice.

Adobe, who at the time bundled a product similar to Figma, Adobe XD, with its creative suite, was seeking to purchase Figma because Figma had quickly grown in the UI/UX design space. Despite getting Adobe XD at no or limited cost as part of their creative suite, consumers still chose to purchase Figma, which focused solely on a UI/UX design tool.

Why? Because Figma’s tool was better. Adobe – which built and manages several flagship products like Photoshop, Illustrator, and InDesign – couldn’t compete with its smaller rival because it leveraged many of its resources on other products instead of the Figma competitor, Adobe XD. As a result, they sought to purchase Figma.

The lesson: Products dedicated to specific uses are often better than bundled solutions with similar functionality.

Health plans should consider this when seeking to purchase enrollment and billing solutions. We’ve seen many plans over the years only consider solutions that incorporate billing and enrollment functionality. Here are four reasons why health plans need distinct enrollment and billing software solutions:

Specialization and Functionality

Enrollment and billing processes have unique complexities. Enrollment software focuses on user experience, data collection accuracy, plan shopping/comparison functionality, and eligibility verification. Meanwhile, billing software excels at billing transactions based on eligibility and rates, invoicing, payment management, and delinquency automation.

Separate solutions can offer deeper functionality in each area, leading to smoother enrollment experiences, fewer errors, more efficient billing cycles, and increased on-time payment rates.

For example, many combined solutions started as enrollment (or even claims) platforms. As a result, the vendor’s core competency is managing the enrollment process and data. The vendor later built a bundled billing solution at a client request, but the software lacks basic functionality, like an integrated premium billing payment portal or automated health plan delinquency management. Those vendors see billing as generating invoices but fail to offer the tools that automate the entire the billing process.

Agility and Innovation

Independent vendors have more flexibility to adapt to ever-changing regulations and industry trends. Enrollment software might need to adjust to new eligibility rules, while billing software might need to integrate with emerging payment methods.

Separate solutions allow each vendor to focus on innovation in their respective field, potentially bringing cutting-edge features and faster updates to their health plan.

Consider that we’ve recently enhanced our billing platform to meet the needs of health plans seeking a Medicare Prescription Payment Plan (M3P) billing solution. Additionally, we’ve leveraged the reconciliation functionality of our core billing platform, William™, to automate the reconciliation of state Medicaid payments. Our focus on billing and finance processes enables us to enhance the billing product faster than those maintaining coupled enrollment and billing solutions.

The same logic applies to dedicated enrollment platforms. By choosing distinct enrollment and billing solutions, you’ll gain new features and functions faster.

Integration

It may not seem intuitive, but integrating a single, all-encompassing enrollment and billing solution can be complex and expensive. Maintaining and troubleshooting a large system can be a burden on IT resources.

Odd as it may sound, opting for distinct enrollment and billing solutions might simplify integration. You can choose enrollment and billing software for health plans with robust APIs that facilitate smooth data exchange.

We speak from experience. We’ve integrated our premium billing software with many disparate upstream and downstream products in the past 15 years. Our solution was built from the ground up to ingest enrollment data, so data integration exists in our DNA. Consider that many coupled solution vendors didn’t design their products to exchange data with external systems, and you may find that distinct solutions are better at managing data.

Plus, decoupling billing and enrollment may increase data quality. Because our system routinely ingests data, we also leverage enrollment data filtering tools to ensure data integrity.

Vendor Expertise and Support

Dedicated enrollment and billing software vendors have experts focused on their specific domains. By choosing distinct solutions, you can leverage the expertise of each vendor, potentially receiving more specialized support and guidance tailored to your enrollment and billing needs.

For example, a single vendor offering coupled enrollment and billing solutions might have a broader team but with less in-depth knowledge of each specific function. Dedicated enrollment and billing software vendors have teams focused solely on their respective domains. These teams become experts in the intricacies of enrollment processes or premium billing.

Focused vendors have a deeper understanding of the specific challenges and best practices within enrollment and billing. They can offer more targeted solutions and guidance to address your health plan’s unique needs. When you encounter issues, dedicated support teams can pinpoint the problem and resolve enrollment or billing functionalities faster.

These vendors also stay current on enrollment and billing regulations and industry trends. They can proactively advise you on upcoming changes and how to adapt your software to comply or optimize efficiency.

While there are some benefits to a single, unified solution, the advantages of distinct enrollment and billing software can lead to a more efficient, adaptable, and cost-effective system for your health plan.

Certifi’s health insurance billing and payment solutions help health plans improve member satisfaction while reducing administrative costs.

Download a Guide to Premium Billing Software for Health Insurers

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