The post is sponsored by Tesia Clearinghouse.
Jay Baker, President of Tesia Clearinghouse, has more than 25 years of experience in healthcare specializing in the electronic data interchange component of the dental industry. Before joining Tesia in 2013, Jay held various executive positions at Envoy and Emdeon.
In this interview, he talks about solving payments for the dental industry by creating a transaction that adds value for both the dental office as well as the benefit administrator.
Question: What is the current electronic funds transfer (EFT) rate for the dental industry?
Jay Baker: Present EFT rates for commercial dental claims are at 15% industry wide. This stagnant provider adoption rate demonstrates that EFT’s are not a viable payment solution for dental providers. This low utilization rate is equally problematic for dental payers, who are still forced to incur the cost associated with paying the vast majority of their adjudicated claims via paper check. It is clear that EFT’s are a flawed solution for providers and payers alike. Knowing this, why does the dental industry continue with efforts to increase EFT adoption? Simply put, there was not a viable alternative in the market place until now.
As the originator of Real-Time Claims processing for the dental industry, Tesia has decades of industry leading experience in developing solutions that solve transactional issues for both providers and payers. We have solved yet another transactional dilemma for the dental industry with the creation of Real-Time Payments (RTP).
Q: How will dental offices benefit from EFT adoption?
JB: Traditional EFT utilization provides only minimal benefits to dental providers. While processing payments electronically can expedite the process, the traditional EFT model creates more concerns than it alleviates for providers. Tesia’s research into provider EFT adoption rates shows that provider concerns over traditional EFT’s fall into four distinct categories:
- Manual plan-by-plan enrollment
- Providers must complete a different enrollment process for each payer that they interact with.
- Inconsistent payment and report process
- Much like the enrollment process, each payer also has unique methods for posting payment information. This process requires the provider to log into each payer’s website daily, to see if payment information has been posted.
- Lack of electronic remittance advice (ERA) standardization
- Once payment information is obtained by the provider, another tedious process of interpreting each payers unique ERA, and posting it into the provider’s ledger still must be completed by the provider’s office.
- Reluctance to share banking information
- Provider offices have consistently voiced concerns over payers having direct access to their bank accounts. This concern is born both out of the possibility of the payer withdrawing funds from their account, as well as the need to share their banking information with multiple payers.
Q: What are Real-Time Payments (RTP) and what are its benefits?
JB: Once a provider has completed the one-time enrollment for RTP, they will receive all payments electronically for participating payers. This removes the burden of going to multiple websites to receive ERA’s, as well as eliminating the need to provide critical banking information to each payer. Providers submit claims, receive standardized ERAs and receive electronic payments all from Tesia in this dramatically simplified transaction.
Q: How will RTPs be more successful than EFTs and how can Tesia increase the number of users?
JB: Firstly, RTP’s will succeed where EFT adoption has failed, because the service was created to alleviate the concerns that dental offices had with traditional EFTs. Additionally, Tesia is uniquely qualified to be the primary mechanism for processing payments in the dental industry because of our market share, transaction processing expertise and marketing scale. Our research shows that the primary user base for RTPs will be offices with one to three dentists per location. This user base, which largely consists of offices that have no intention of adopting traditional EFTs, accounts for 80% of all dental payments made industry wide.
Tesia plans to rapidly grow the RTP user base through an exclusive relationship with our sister company, Renaissance Systems and Services (RSS), who is the second-largest provider claim service in the country. The RSS user base of more than 28,000 dentists, primarily consists of dental offices with one to three dentists per location, and is expanding at a rate of 2,700 dentists per year.
RTP’s will also leverage the payment processing system created by our sister company Electronic Lockbox Services (ELS). The ELS payment processing system has successfully processed more than $200 million in payments for dental offices and serves as one of the primary hubs for RTP transactions.
Our current marketing scale allows us to reach every dental office in the country at least five times per year. Additionally, we have committed to investing $25 million over the next four years, to expand both infrastructure and key personnel to support the current and future RTP book of business. Eleven key payers have committed to utilizing RTP’s in the immediate future, with many more expected to do so in the coming months.
Q: In 2012, Tesia become part of Renaissance Electronic Services (RES). Who is RES?
JB: RES was created to provide integrated solutions for the dental industry. Wholly owned subsidiaries of RES include: Renaissance Systems and Services LLC, Tesia Clearinghouse LLC, Maverest Dental Network LLC and Electronic Lockbox Services LLC.
More than 28,000 dentists use RES services to submit more than 65 million claims, 3 million attachments and 16 million related transactions annually. An estimated $350 million in billed charges are flowing through its PPO network annually. RES is also processing more than $200 million in patient payments and 3 million patient statements annually. Operations span six locations in the Indianapolis area, with 80,000 square feet of office space, more than 230 employees, and three fully redundant data-centers.
 Federal Register, Vol 77, No 155, August 10, 2012, Dept. of Health and Human Services