|Health Plan Develops Real-Time Claims Tools
Helps Providers And Members Get Handle on Payments, Co-Pays
Hospitals, ambulatory surgical centers, imaging setters
and other types of healthcare providers can determine a member’s
financial obligation before a service is rendered and collect payment
when the member receives care using real-time tools developed by
Some 250 providers in Highmark’s 49-county service
area in western and central Pennsylvania began using real-time tools
last November, and during the first two months of this year providers
submitted nearly 10,000 transactions that identified approximately
$395,000 worth of payments due frommembers, the health plan said.
"These real-time capabilities are especially helpful to
Highmark members with high deductibles, coinsurance or other cost
sharing, to better understand the actual cost of healthcare services,"
the health plan said. Some 730,000 Highmark members are enrolled in
health plans with cost sharing that include deductibles and/or
coinsurance for a network services.
The health plan said real-time claims processing and
real-time member liability estimation "assists physicians and other
providers to receive payment for their services and relieves the
guesswork for members about the cost of their medical treatment."
Members know their actual out-of-pocket health care costs based on
their benefits when they schedule or receive health care services.
Highmark said providers are telling the health plan that
real-time claim processing has "enabled their patients to better
comprehend the cost of services they have received, understand what
they owe and more easily make payment arrangements."
In terms of provider reimbursement, the real-time tools
have reduced reimbursement timing from Highmark to within three days
instead of 15-20 days, the health plan said.
"All of Highmark providers are able to use the real-time
tools through Highmark’s provider portal NaviNet." The health
plan also said it is working with practice management system vendors to
integrate the real-time tools with their software.
"This point of service payment method is also receiving
favorable reviews from members," Highmark said. "More than 88 percent
of members whose providers use real-time tools were satisfied with
For more information on Highmark, visit www.highmark.com.