Member Portals

In today’s competitive market of healthcare insurance, one of the most important biggest challenges healthplans face is customer satisfaction.  Health insurance consumers are demanding more information be readily available from their healthplans than ever before.  FluidEdge is helping their healthplan clients address this challenge through implementation of various portals.  Portals provide electronic gateways via the internet to the insurance related data maintained by the healthplan.  Whether you need to develop, implement or enhance your healthplan portals, FluidEdge consultants have the expertise needed to develop the most effective portals to meet the needs of your consumers.

Member Portals: Your member portal could be the first view or interaction a member has with your organization.   Whether you have a hundred members or over a million members, FluidEdge understands your need to ensure your member portal is secure, user-friendly and comprehensive.  From the member’s view of their eligibility and claims data, to your call center staff’s ability to access to this data, it is imperative that the portal meet a multitude ofneeds.  FluidEdge can assist you in developing a member portal that offers optimal benefit to your members, such as:

• Obtain information about various plan options, including quotes
• Provide access to their current plan for insurance coverage (copay, coinsurance information, exclusions, etc.)
• Identify physicians participating in their health plan
• Review and submit inquiries about past and current claims history
• View EOBs (Explanation of Benefits)
• Participate in wellness programs and obtain information about healthy lifestyles being offered for preventative medicine

Employer Portals: Employers are usually the first responders to employees  with questions regarding their health insurance,  and need  information to answer those question must be readily available.  FluidEdge understands these requirements and can help you ensure that your employer portal is intuitive and easy to use, yet robust enough to meet the needs of all your employer participants, including:

• Provide access to employee’s selected benefits, payroll deductions, and claims history
• Status of system maintenance and emergency down times
• Obtain reports on their own company’s utilization as compared to other similar healthplan clients (such as high-risk volumes, reimbursement for healthcare services, coverage provided, etc.)

Physician Portals: The physicians are also looking for easy access to and readily available information about their patient population and their contractual agreements with healthplans who provide coverage for those patients.   As with other types of portals, those designed for physicians also provide benefits, such as ability to:

• Verify patient’s insurance eligibility, benefits and claims
• Submit and edit claims for services delivered to patients
• Manage information on referrals and authorizations
• Obtain reports about the practice’s utilization (such as risk, disease, reimbursement, etc.)
• Access healthplan policies and procedures to support staff education

FluidEdge has been involved in all aspects of the project lifecycle to establish member, employer, physician, and agent portals for payer organizations.  Our consultants can assess business requirements, recommend portal design, conduct due diligence for vendor selection and manage system testing and implementation.  Whether you are developing new or expanding existing portals, FluidEdge can help you enhance customer satisfaction and operational efficiency through development of an innovative portal strategy.

FluidEdge has the expertise and the tools needed to establish state-of the-art portals for secure access to the information the payer organization needs to share with their participating members.