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Home / News & IndustryManaged Care Insight and Analysis
Updated: October 12, 2010
Insurers Eyeing ATM-like Technology To Streamline System

New Jersey health plans are betting that the technology used in ATM machines will streamline insurance.

Five health plans are collaborating on an initiative to reduce time and expense for physician practice paperwork required for each patient’s office visit.

America’s Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association (BCBSA) are sponsoring the regional and statewide initiative.

"This is a leadership initiative on the part of health plans to simplify administrative processes and free up clinicians to spend less time on paperwork and more time with patients," said AHIP President and CEO Karen Ignagni.

Savings are estimated in the hundreds of billions of dollars when all of health care moves to automation and standardization, the participants said. The initiative will simplify information flow between health plans and doctors’ offices, and between health plans and hospitals.

Participating health plans, representing 95 percent of state residents with private health insurance, are:

  • Aetna
  • AmeriHealth New Jersey
  • CIGNA
  • Horizon Blue Cross Blue Shield of New Jersey
  • UnitedHealthcare

Five physician organizations are also collaborating on the project:

  • Medical Society of New Jersey (MSNJ)
  • New Jersey Academy of Family Physicians
  • New Jersey Association of Osteopathic Physicians and Surgeons
  • New Jersey Medical Group Management Association
  • Partners in Care Corp.

"This new tool will allow our physician practices to check patient eligibility, deductible amounts and other critical benefit information from one source," said Michael T. Kornett, CEO of MSNJ.

The initiative addresses the need for one-stop service in electronic transactions that physicians have advocated for strongly, and is a requirement to achieve the level of savings that is ultimately possible.

It replaces a cumbersome system in which physician office and hospital staffs spend considerable time at considerable expense accessing multiple channels to get the information needed to complete basic requirements for confirming eligibility, billing and referrals.

While the first year constitutes a pilot that will incorporate the feedback of users and the opportunity for adjustments, the initiative is designed to be permanent. The ultimate goal is to develop regional services that span the entire country.

The New Jersey initiative offers opportunities to simplify the work associated with patient visits and achieve savings, including providing physicians and hospitals with information in "real-time" that:

  • Allows office staff to quickly determine key eligibility and benefit information (e.g., co-pays, co-insurance, and deductibles, and differences in coverage for services provided in- versus out-of-network), thus minimizing time and expense needed for such purposes;
  • Gives physicians access to current and accurate information on the status of claims submitted by physician offices for payment by insurers. This will minimize the need for follow up steps by office staff or submission of duplicate claims that delay rather than expedite payment in most systems;
  • Tests real-time referrals and timely pre-authorization of services; and
  • Provides for the online submission of healthcare claims.

For more information on the multi-payer portal project in New Jersey, visit http://bit.ly/bnLdZj.

Addresses: America’s Health Insurance Plans, 601 Pennsylvania Avenue NW, South Building, Suite 500, Washington DC 20004, (202) 778-3200, www.ahip.org. The Blue Cross and Blue Shield Association, 225 North Michigan Avenue, Chicago, IL 60601; www.BCBS.com.


  This article was taken from:
The Executive Report on Managed Care

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