Brooke Kirby
Senior Director, Tech-Enabled Services
FairPay Flex, Enlyte’s specialty bill review solution, offers significant savings potential for workers' compensation medical bill review. Here are some expert tips and tricks to make the most of this powerful tool.
1. Shine a Light on the Grey Area
FairPay Flex shines in grey areas where traditional solutions fall short. It's particularly effective in states with gaps in fee schedule coverage or where no clear objective value is directed by the state. Identify states in your portfolio where fee schedules are incomplete or non-existent and prioritize implementing FairPay Flex in these areas.
2. Leverage State-Specific Advantages
Different states offer varying opportunities for specialty bill review success. For example, FairPay Flex can outperform network solutions by 20-30 points, especially for inpatient, outpatient and ambulatory surgery center bills. Start with non-fee schedule states like Arizona, Iowa, Missouri, New Hampshire and New Jersey where FairPay Flex can be particularly impactful with average savings rates of 62%.
3. Optimize Bill Selection
FairPay Flex has an automated, state specific, bill selection criteria for multiple bill types such as: ambulatory surgery centers, hospital inpatient/outpatient, durable medical equipment, ambulance, out-of-state and professional bills.
To maximize savings, send all bills through the system to automatically select eligible bills.
4. Integrate Into Your Existing Workflows
FairPay Flex easily integrates into your current bill review process, whether you're using Enlyte's bill review platform or another system. Partner with the Enlyte team to determine the best integration method for your workflow.
5. Strategically Position FairPay Flex in Your PPO Hierarchy
For optimal results, position FairPay Flex as the primary solution within your PPO hierarchy in non-fee schedule states. Ask Enlyte client services to perform a PPO optimization analysis to ensure you are maximizing savings in each state.
6. Customize to Fit Your Needs
Take advantage of FairPay Flex's customization features by working with the Enlyte team to tailor the solution to fit your specific needs: You can turn off specific providers if needed to protect provider relationships, or adjust settings based on geography or employer mix.
7. Utilize the Dedicated FairPay Flex Support Team
A dedicated customer service team and legal experts handle provider inquiries, disputes and complex cases efficiently. Establish a regular cadence of strategy sessions with the FairPay Flex team to discuss challenging cases and optimize your approach.
8. Monitor Performance and Optimize
Regularly review the monthly performance and dispute reports. Use this data to fine-tune your implementation and address any areas of concern. With optimization you can expect 54-56% average savings across jurisdictions (up to 65-70% in some states).
9. Address Provider Pushback Proactively
Some provider pushback is normal and a sign that you're not overpaying. To handle this, direct all provider inquiries to the provider call center listed on the EOB, utilize the dedicated dispute resolution service, and ensure your team is trained to immediately redirect provider inquiries to Enlyte.
10. Stay Informed About Enhancements
Ask your client service team about new FairPay Flex features, such as improved handling of out-of-state bills and non-valued codes, to ensure you're maximizing the solution's potential.
Using these tips, you can protect your organization’s precious resources and time with FairPay Flex—a powerful cost-containment tool designed to ensure you’re paying fair, reasonable rates for medical services.