An automated process for posting referral authorizations has eased a cart-before-the-horse problem in which claims from specialists were being rejected by Medical Mutual of Ohio because they got there before the referrals did.
Implemented in January 1995, the phone-based interactive process allows primary-care physicians to get referrals posted within 24 hours, says Mike Manco, president and chief executive officer of Interactive Healthcare Technologies, which developed the service.
Once the information is correctly entered, confirmation letters go out to the primary-care doctor and specialist, including a confirmation number as reference.
That avoids the arguing back and forth about whether a referral was forwarded to the insurer. Claims don't get held up unless a doctor truly didn't enter a referral, Manco says.
Before the electronic process, posting took up to 21 days from the time a physician phoned in or faxed a referral to an operator, he says.
The process has eliminated 50% of all calls regarding referrals, he says. About 20,000 referrals are processed electronically each month from 3,500 primary-care physicians to 16,000 specialists.