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Major Insurers Create 'One-stop' Shopping for Insurance Filing, Verification
New Jersey, Ohio Projects Seen as Beneficial for Physician Offices
"This is what physicians have been asking for -- they have been asking for one-stop shopping," said Susan Pisano, AHIP's vice president for communications. "They have been asking for standardization in electronic transactions."
In creating the project, AHIP and the BlueCross and BlueShield Association convinced the largest insurers in the two states to participate, thus, for the first time, giving physicians the ability to access information from a variety of insurance carriers through a single Web-based portal.
"By logging on to one Web site, physicians can get eligibility information and cost-sharing information," said Pisano. "If the patient needs a referral, the physician can get them a real-time referral. Physicians can also check on the status of claims and can file claims, all through the same portal."
"No one insurance company could make this happen on their own, so we acted as a convener," said Pisano. "In that role, we had all of the insurance companies agree to use the same electronic standards."
Insurance companies are paying for the programs, so there is no cost for physicians to participate in the projects, according to Pisano. The projects are considered pilots because they each contain an evaluation component; physicians will provide feedback on the project within the next 12 months so that any problems with the programs can be resolved.
However, Pisano stressed that the two projects are designed to be permanent, and that the ultimate goal is to establish similar programs in other states so they eventually span the entire country.
Proponents of the New Jersey and Ohio initiatives are convinced the projects will save millions on an annual basis by reducing administrative time and costs.
In New Jersey, NaviNet is the vendor company operating the Web portal. Family physician Stephen Nurkiewicz, M.D., of Hammonton, a solo practitioner, has been using the company's system for the past several years. Before the launch of the New Jersey project, however, only a few of the state's insurance carriers were using the portal, which created a piecemeal system, according to Nurkiewicz.
"We were frustrated by the fact that we didn't have one Web-based source to look up all the insurance information," he said. "For most patients, it is so complicated, they don't know their copay amount or do not bring their insurance information with them, or they are elderly and are frequently confused by the information."
The access to real-time data about eligibility, copays and coverage is perhaps the greatest benefit to family physicians, said Nurkiewicz. "On the back end, there is a claims review of what payments should have been paid or have been paid." This has particular relevance for family physicians, according to Nurkiewicz. "Our margins are so slim in family practice that every dollar matters. If you are backlogged 90 days, you can't pay your electric bill."
Nurkiewicz expects the program to save administrative time and to reduce the frustration level between physician offices and patients. "There should be a positive relationship between patients and physicians getting the insurance cleared up before you have to deal with the patient's illness," he said. "Insurance issues often get in the way while trying to treat the patient's illness."
The New Jersey AFP is actively promoting the program through correspondence with its membership.
"Any program that reduces the administrative burden on family docs is a worthwhile program," said Ray Saputelli, C.A.E., EVP of the New Jersey AFP.
Saputelli said family physicians in New Jersey are cautiously optimistic about the program. There is "always a skepticism that goes along with almost anything that comes out of the managed care environment these days," he said. But "by and large, family physicians are hopeful that the industry is really working to reduce some of the unpaid administrative burdens they place on family docs."
The Ohio AFP, meanwhile, has publicly supported the program, but not the actual Web-based product, which is being providing by Availity. According to Kate Mahler, deputy EVP for the Ohio AFP, the chapter has not "seen the product in action."
"We want to make sure that before we endorse the product, it is actually benefiting our members," said Mahler. "Our physicians need to have a streamlined administrative process that spans the gamut among the health plans."
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