Much more than a bill clearing house

From invoice clearing to The Private Practice Register, Healthcode has been in the vanguard of a technology revolution in the independent healthcare sector for two decades. But while its online solutions are widely used to automate time-consuming administrative tasks, how much do you know about the company behind them? Peter Connor gives the low-down.

1 Healthcode marked its 20th anniversary in 2020

Healthcode was established in 2000 with an urgent mission – create an invoice clearing service for healthcare providers who send electronic bills to private medical insurers. The company later launched its Clearing Service, which now processes invoices worth around £3.3bn each year.

But it has not stopped there. Over the last 20 years, the company has continued to apply its energy and expertise to develop new online services that help healthcare organisations connect and operate more efficiently. 

In 2020, Healthcode was recognised at the annual HealthInvestor Awards which celebrate excellence in the private healthcare sector, winning IT innovator of the year and being short-listed in the technology provider of the year category.

2 Most private providers use Healthcode’s Clearing Service to submit electronic bills for validation

Before Healthcode developed its Clearing Service, most providers printed and posted invoices to insurers, an inefficient and time-consuming process which could lead to lengthy delays in payment if the bill did not meet the insurer’s rules or in the event of query. 

Now around 60% of practitioners and 98% of hospitals generate electronic bills using the specialist software of their choice and then submit them online through Healthcode’s Clearing Service. 

Each invoice is then automatically validated against the specific rules set by the private medical insurer (PMI). 

The information checked includes:

Invoice number and date;

Provider details, name, number or professional number, specialty and billing address;

Patient’s full name, birth date, address, insurance company/paying organisation, policy number (in the correct format), diagnosis and description where applicable, lead consultant;

Treatment type, date, service delivered, procedure code and description where applicable, fee;

In the event of an error, the system tells practitioners exactly what is missing or incorrect, allowing them to correct the invoice and resubmit. 

A status display shows when an invoice has been successfully validated and received by the PMI.  

3 In 2019, Healthcode’s Clearing Service checked and processed 28,000 invoices daily 

The volume of electronic bills processed and validated by the Clearing Service has risen every year since it was launched. 

In 2004, it was just under 2m a year; by 2012 it was more than 3m, but it had rocketed to over 7m by 2019. 

Initially, this growth was driven by hospitals, but in 2018 the number of bills from non-hospital providers – including independent practitioners – overtook those from hospitals. 

The Clearing Service has helped make electronic billing standard practice across the sector which benefits providers as much as PMIs on the following grounds:

Cost – electronic billing entails a fraction of the printing, postage and manpower costs associated with paper billing; 

Security – all data is encrypted; 

Efficiency – bills can be submitted to the leading PMIs from one online platform  

Cash flow – validated electronic bills enter the insurer payment cycle quicker and can be paid as soon as one week after submission.  

4 The Invoice Clearing Service is one of a range of online solutions developed by Healthcode for independent practitioners

While Healthcode is associated with electronic billing, its technical expertise means it has also become a leading provider of online solutions for independent practitioners, including:

 ePractice Electronic billing and payment tracking software; 

 ePractice Practice management software ;

 Secure messaging;

 Clinical coding tools;

 The Private Practice Register (The PPR).

5 Healthcode operates independently of private medical insurers

Healthcode is jointly owned by Aviva, AXA Health, Bupa, Nuffield Health and Vitality-Health. 

It operates independently of its shareholders and therefore does not make decisions based on the requirements of the UK private insurance market. Share-holders do not have access to data held or processed by Healthcode.

6 The Private Practice Register (The PPR) is the first central information resource to connect practitioners, hospitals and private medical insurers

The PPR was first released in 2016 to fast-track the process of applying for private medical insurers’ recognition.

The idea was for independent practitioners to have a secure online platform to store all the relevant practice information and supporting documents so it would be far quicker and easier to maintain accuracy and be accessible to organisations that needed to know. 

More than 20,000 practitioners now use The PPR to control their profile and connect to the major insurers and more than 300 hospital providers. 

It provides an efficient way to ensure these stakeholders can access details of their current practice, such as contact information, NHS and private practice information, medical secretary details, publications, bank details, medical indemnity certification, insurer recognition details and fitness-to-practise information. 

This makes it easier to maintain insurer recognition, hospital practising privileges and get paid.

Practitioners who join The PPR are also showing their support for appropriate information-sharing across the private health sector, which is a prerequisite for safe, high-quality care. 

7 Healthcode meets stringent information security standards to protect confidential data

To safeguard the enormous quantities of sensitive financial and patient data it processes for independent practitioners, hospitals, NHS private patient units and insurers, Healthcode uses a range of stringent data protection measures:

Systems are secured in accordance with internet banking conventions, using 2048-bit certificates for full end-to-end encryption.

Its infrastructure is in the UK and is of enterprise quality, designed to contain no single point of failure.

Healthcode takes a back-up copy of the data regularly, which is securely stored. 

Users must have their own log-in ID and password and are prompted to change their password every 90 days. Accounts are locked if they are not accessed for 90 days.

Its Information Security Manage-ment System complies with the requirements of ISO/IEC 27001:2013 and we have maintained this accreditation since achieving it in 2009. We are also certified by the Government-backed Cyber Essentials scheme.

8 All Healthcode’s solutions are designed to be interoperable 

Healthcode believes technology should not create barriers but instead make it easier for organisations and practitioners to connect and share information efficiently and securely. 

Its developers therefore aim to ensure solutions are compatible with the systems used by key stakeholders in the healthcare sector. 

Take the Clearing Service, for example. All the leading insurers are able to accept invoices submitted this way: AXA Health, Aviva, Bupa, Bupa Global, Cigna Health-care, Healix, VitalityHealth and WPA. 

And at the front end, the service is open to practitioners who use Healthcode’s own ePractice software and those using common third-party practice management software such as DGL or Lumeon. 

Over the years, the company has consistently promoted the value of collaboration within the sector, from the development of common industry standards in areas like billing and data, to sector-wide projects like The PPR.

9 Healthcode is developing a centralised e-booking service to transform access to private healthcare

The PPR is Healthcode’s most ambitious project to date and continues to evolve in response to the needs of the industry. 

However, the company has no intention of standing still. Inspired by the computer reservation websites in the travel and hospitality industries, its development team’s current project is a centralised electronic booking application that will transform patients’ access to private healthcare.

Peter Connor (right) is managing director of Healthcode