With health savings accounts gaining prominence as a cost-effective alternative to employer-sponsored insurance plans, automated claims processing is expanding beyond payer and provider back offices and into an important new consumer channel.

Introducing consumers into what has traditionally been a domain for payers and providers (and to a lesser extent, employers) could permanently alter the claims processing dynamic – a development authorities believe will have profound ramifications, especially for health insurers.

“HSAs are a whole new compact for providers, payers and consumers,” said Bruce Milne, vice president and general manager of industry solutions for Austin, Texas-based Vignette. “Up to now, all the policies have been well established, the players know the thresholds for delivery and now with consumers entering the scene, it brings about a whole new set of relationships. A brand new ecosystem has been created.”

As it stands, Web-based applications serve as an ideal vehicle for directing consumers into the automated claims environment, Milne said.

“The Web is the primary model for payers to communicate with members,” he said. “It allows payers to talk with consumers in a different way – not only do they adjudicate straight-through claims, they can offer health and wellness information. It’s a more direct relationship than they had before.”

The consumer factor indeed represents a new wrinkle in claims automation, which has vendors scrambling to keep pace, said Shawn Jenkins, CEO of Benefitfocus.com.

“The overall complexity of the system is growing faster than the technology,” he said. HSAs are a “disruptive” influence on the system because they raise questions about how established methodologies should change.

“How do you settle HSA claims? With the payer? The bank? We’re trying to hold it together,” Jenkins said.

Benefitfocus.com got its start by facilitating electronic health plan enrollment for employers. The platform, which company officials call the Dream Data Network, has evolved into a universe for Web portals and behind-the-scenes data exchange. Its functionality has developed to the point where users can review patient records for various purposes, said John Smith, vice president of technology.

“The Dream Data Network allows payers, members and providers to stay synchronized around the information, including patient profile, eligibility, deductibles and claims adjudication status,” he said. “It provides the integration piece that has been missing so that they can communicate in near real time.”

To be sure, automated platforms are making providers’ lives easier from the standpoint of knowing – practically up-to-the-second – a claims’ status and content. As its name suggests, Atlanta-based Navicure is focused on guiding physicians through the labyrinth of convoluted billing procedures.

Navicure CEO Jim Denny refers to his business as a clearinghouse that provides revenue cycle management for physician practices and says the objective is to take the mystery out of claims processing.

“We make information available to physicians in ways they can readily use,” he said. “We provide real time tracking mechanisms so they can follow a claim through adjudication. Whenever a claim is accessed, it’s recorded. Whatever the status, it’ll tell you.”

As a clearinghouse, Navicure also strives to take the guesswork out of claims denials by standardizing error messages across the payer spectrum.

Atlanta-based Piedmont Medical Care Corp., a clinic that files claims for more than 100 physicians, has been using the Navicure system for nearly three years and has seen a dramatic drop in claims rejections as a result, said Leyton Braud, director of Piedmont’s central business office.

“We file 35,000 claims per month and only get about 150 to 200 rejections,” Braud said. “That is a very tolerable level.”

Navicure’s role as a conduit to payers has helped tremendously in cutting through the red tape that usually pops up whenever a new physician is entered into the system, he said.

In transitioning from a partially manual to fully automated claims processing system, Braud said Piedmont has gotten the results it was looking for: simplicity, context, quantification and most importantly, a vastly improved collections rate.