Posted on 12 Feb 2010
America's Health Insurance Plans and the Blue Cross Blue Shield Association, two giants in the insurance industry trade groups, announced the start of a new pilot program in which five of the largest private insurers in New Jersey will offer doctors and hospitals the ability to use a single Web portal to check a patient’s coverage and track claims, regardless of which of those five health plans they are enrolled in.
The effort is aimed at one of the most vexing problems in the nation’s insurance system: hospitals and doctors spend enormous amounts of time and money trying to determine whether a patient has coverage or why a claim was denied. Tens of billions of dollars each year are said to be wasted because of such administrative inefficiency.
The insurers started a similar project last fall in Ohio, where about 700 medical practices are using a single Web site to get access to insurance information about their patients.
“The pilots are a great example of the industry’s commitment to voluntarily make progress eliminating the administrative hassles that physicians face,” said Ronald Williams, the chief executive of Aetna, the large insurer, who is among those leading the industry’s overall effort.
The promise to produce significant savings through streamlining paperwork was made as part of the industry’s discussions in June with the White House. But the pilot project effort has taken place parallel to the general discussions over the health care legislation, said Karen Ignagni, the president of America’s Health Insurance Plans.
The move by the insurers to develop standards and systems to make it easier for doctors to determine a patient’s coverage and get paid will continue regardless of the status of any federal legislation, she said.
“We wanted to make sure we were taking a leap,” said Ms. Ignagni, who said the two state projects were a way for the insurers to test different Web systems and see what technology worked best for the hospitals and doctors before eventually beginning other efforts.
Insurers in Florida and California are already talking about starting their own initiatives, she said. “We want to move this along very, very quickly so we can offer this in all the states,” she said.
Under the New Jersey pilot program, which should go live by April, doctors and hospitals will be able to log into a single Web portal, offered by NaviNet, which already provides similar Web systems for individual health plans.
Aetna, AmeriHealth New Jersey, Cigna, Horizon Blue Cross Blue Shield of New Jersey and United Healthcare, which represent about 95 percent of the people covered by private insurers in the state, are participating. Doctors will able to check instantly whether a patient has coverage and be able to track the status of the claims.
But while doctors are able to go to a single Web site, they must still get access to information about a particular patient from subsections of the site fed by the individual insurance carriers. And not all of the health plans will immediately provide the same level of information.
While some plans will allow a doctor to immediately determine how much a patient will owe toward the cost of an expensive treatment, for example, taking into account how much the co-payments involved and how much of the patient’s deductible has already been met, others will offer only the outlines of a customer’s coverage.
The doctors in Ohio using the system there say it is helping to make it easier to find out if someone has coverage or to check a claim. The new system is “a good start,” said Mark Jarvis, a senior official for the Ohio State Medical Association, but he said more work was needed to streamline the process.
Some insurers are clearer than others about why a claim is being denied, he said, and a doctor’s office must still enter billing information twice — once for its own practice management system and again for the new site.
“What we really need to get is the information integrated into the workflow in the office,” Mr. Jarvis said.
The industry acknowledges that insurers are still in the process of deciding on standards. “We have a long way to go,” said Mr. Williams of Aetna. But he compared the current industry initiative with the early days of bank A.T.M.’s, when a customer’s banking card did not work in every machine.
“All of these things, over time, did get standardized,” he said.
For doctors like Stephen A. Nurkiewicz, being able to easily find out if a patient has coverage before an office visit is a tremendous step forward. As a solo practitioner in Hammonton, N.J.,
Dr. Nurkiewicz already uses a NaviNet system for some of his dealings with the insurers and looks forward to being able to tell before he sees a patient whether that patient really has coverage.
“It’s got to be better than it is now,” he said.