Improving Liberty HealthShare Part 1: The ShareBox

Last time, I wrote about the current status of sharing, and some of the delays in processing medical expenses. This time, I’m presenting a list of technology tweaks–most rather simple to implement–that would reduce the staffing needs at Liberty. If a member can answer their own question via the ShareBox interface, that’s one less phone call or e-mail asking someone to find it for them. If a member can submit data so that it’s ready for Liberty to process, that’s one less keystroke we have to pay for in administrative expenses. Here goes:


Every action should have a date visible to the member. No excuses, and an easy fix. No member should be wondering how long it’s been since a bill was reviewed, how long it’s been since it was submitted for sharing, etc. An Explanation of Sharing should include when it was prepared.

Show the date when an expense was queued for sharing. If it’s missed a cutoff for the next round of payments, indicate as much.

E-Mail Notifications

This goes with showing dates, but still goes toward keeping the member apprised of bill statuses. If Liberty takes action–whether identifying a need more information, submitting a bill for sharing in full, paying a provider, rejecting part or all of a bill, or rejecting some of the amount billed for a particular service–send a notification.

Submission Process Improvements

Right now, when a user submits a bill, they submit a scanned copy, enter an amount, and can fill in a free-form text field with a description of the bill and provide some very basic info (including the amount already paid). It’s simple for the member, but members could contribute just a bit more effort at this stage and significantly reduce the burden on Liberty staff.

Here’s what I’d propose:

  • Make the existing form a first step. Collect that information (provider name and address, amount paid, bill amount, etc.), and upload documentation
  • Let the first step put the expense in queue for processing. After that display an optional (at least for now) form where the member can enter each ICD code and line item cost.
  • Display the ICD description and use the blue book pricing information to show additional information. Include the “fair price” estimate, along with a running tally of portions to be applied to the AUA, and a subtotal of the expected member portion of the bill. This is all easily figured math at Liberty, but is a source of confusion for many members.
  • Allow edits of the bill information, including creation of member payment entries, and adjustments to the bill by the provider (i.e. accepting a Liberty price, progress payments, etc.). Include with this functionality a place to include additional document uploads, as may be needed when ICD codes are modified, or filled in where omitted.
  • For providers that bill Liberty directly, quickly scan bills and make them available in the ShareBox. Allow members to add additional information, including the data entry outlined here, if they get to it before Liberty staff does.

My thinking is that if the member is able to enter the information in this way, Liberty staff aren’t performing data entry tasks. Asking for ICD codes to be entered and showing price estimates will help members plan payments to providers, and help to ensure that the necessary information is present on the submitted bills.

If member-submitted details prove accurate enough on the whole, the process can become increasingly automated. Liberty staff can focus efforts more on complicated cases and auditing, instead of the mundane and routine. To the extent that additional member data entry is optional, completion of that step by the member would allow advancing the bill to the next step in the sharing process. In other words, the member would advance their bill from a data entry step to a review step, with much more prompt issuance of the EOS.

Liberty has the relevant data, it just needs to be put to use. Especially for pre-notifications, entering estimate information gives members a better chance to discuss pricing before a service is rendered. At the very least, a member is able to make payments on their portion in a more timely manner without throwing a wrench into the process.

Sorting/Customizable Columns

Especially for those less fortunate, that have ongoing medical concerns or have had major accidents with lots of bills from a variety of providers, being able to quickly sort a list of submitted expenses to find specific ones would be a big help. The filter function present currently helps a little, sorting would go a lot further.

Just like virtually any other table or list in an online format, each column should be sortable by clicking on the column title. Any data extracted from a bill/claim should be able to be displayed as a column on the medical summary page, including:

  • Service date
  • Member submission date
  • EOS Number
  • Submitted Amount
  • Shared Amount
  • Unallowable Amount
  • Amount Applied to AUA
  • Amount Paid
  • Check Date(s)
  • Last action
  • Status (e.g. processing, submitted for sharing, etc.)

Search Function

Nothing fancy needed here. Just an extension of the existing filter tool, that allows a search of all fields from one location. Let us search for “Jones” whether it’s in the patient’s name, facility name, street address, or doctor’s name.

Incident Hierarchy

One of the things that separates Liberty and some other health sharing organizations from conventional insurance is the provisioning of care in the context of “incidents”. Some plans have a per-incident limit, and the inclusion of certain services/medication (like prescriptions) is only shareable within a certain period of time from the diagnosis or incident.

That said, bills should be able to be displayed in hierarchical form by incident, with totals for the incident and the amount remaining to the incident limit readily visible.

Include with this structure a mechanism for linking/viewing pre-authorizations, and identifying the appropriate pre-authorization when an expense is submitted (e.g. adding pre-authorization number to expense submission).

Flow Chart/Checklist

For any medical expense, there are a series of things that have to happen, both in terms of internal process controls at Liberty, and things involving patient, member, and provider. Show a checklist and/or flow chart for each bill, indicating which steps have been completed, and which still need to be completed.

Revision Histories

No system is ever going to be perfect. When an EOS is prepared, and the member finds an error or something changes, don’t replace the old one entirely. Keep the old one, indicate dates and revision numbers on both. Show them all in the ShareBox. Make it easy for members to see when problems have been addressed, and use the information to help identify particular types of bills that tend to be error prone.

Explanation of Sharing Detail

For every expense I’ve ever submitted, the explanation of sharing shows only a service date, and the dollar amounts for each bill. Since procedure codes are necessary for the submission, they should be similarly laid out on the EOS, with dollar amounts for each line item. Make it easier for members to catch mistakes, and easier (line numbers!!) for members to communicate with Liberty when phone calls and/or correspondence becomes necessary.

Accounting Ledger

I’m going to sound like an accountant here. For every expense submitted, every explanation of sharing, and every check written, there should be accounting within the walls of Liberty tracking how we arrived there. Let members see the double-entry accounting registers for their accounts in the ShareBox. Show bill amounts submitted in a “payable” account, with re-pricing, AUA amounts, and pending/shared amounts subtracting from that. Make it easy for members to see what’s outstanding, what’s waiting to be shared, what’s not going to be shared, etc., in a reconcileable ledger format.

Electronic Fund Transfers

Liberty now gives members the option of submitting the monthly share amount via ACH (i.e. transfer from a checking account), in addition to a credit card. Instead of mailing paper checks, offer the option of an electronic transfer to the member’s bank account. It’s faster (maybe not a good thing for Liberty…), but more importantly cheaper.

For members that pay by credit card, process smaller expenses as refunds to the credit card account. Variable credit card processing fees are refunded to Liberty when a credit is processed. The cost to transfer funds via a refund transaction is effectively less than zero.

Your thoughts?

What other ShareBox improvements would help you or help Liberty process your expenses? What information do you look for that you can’t find online? Let me know what you think. In coming posts, I’ll address some more fundamental accounting, organizational, and transparency concerns I have, and how they might be addressed.

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