An Ohio-based insurer is so serious about getting providers to submit claims electronically that it's offering a way to do it for free.
Using technology created for touch-tone telephones, Medical Mutual of Ohio aims to eliminate hurdles that until now have kept lower-volume physician offices and ancillary facilities from considering electronic data interchange.
A telephone number establishes a direct link to the claims department database, triggering computerized voice prompts that get the job done without computers or transaction fees.
The result: improved accuracy of data compared with paper-based claims procedures, and less chance the insurer will reject a valid claim, says Lee Helis, executive vice president of statewide operations for Medical Mutual, the new name for Blue Cross and Blue Shield of Ohio.
Providers also get their claims in the hopper for reimbursement by the time they hang up the phone, instead of waiting days or weeks for faxed forms and mailed envelopes to make their way through a paper process.
All those benefits have been available for years to providers using personal computers and electronic claims clearinghouses to submit their bills to Medical Mutual and other insurers, Helis says. About 40% of Medical Mutual's claims traffic was received electronically before the new phone-based method was developed.
But those claims were from high-volume providers that could easily justify the investment in overhead, Helis says. That still left about 11,000 medical/surgical providers and 4,700 dental accounts steadfastly submitting all their claims on paper.
For Medical Mutual, the situation threatened to become an impediment to service in the midst of a push for growth in enrollees. "The goal (of the claims operation) is to grow as your business grows without added costs or people," Helis says.
The insurer, with about 1.5 million enrollees, has added 100,000 annually for the past four years and is trying to keep that string going, he says. But to serve all those accounts accurately, the claims operation has had to add steps such as microfilming incoming paper claims submissions to keep from losing track of any of the contents, he says.
The process also depends on nimble fingers to key all the data into the computer system without introducing errors such as transposed account or identification numbers, he adds. Electronic submission bypasses those delivery and processing steps that cause many of the errors and delays.
But for providers sending only a few claims a day, the computer route wasn't an option, says Mike Manco, president and chief executive officer of Interactive Healthcare Technologies, a Westlake, Ohio-based supplier of phone-based transaction services.
The vendor discovered three principal reasons for the resistance:
The cost-a personal computer, related software and a claims-submission service-was thought to be too high in relation to the volume of claims an office generated.
Providers didn't understand the advantages measured in personnel time, claims turnaround time and resubmission of rejected claims. "To them it costs 32 cents to submit a claim, and that's the cost of a postage stamp," Manco says.
Providers felt the insurance company was the beneficiary of electronic data interchange and was motivated out of self-interest.
The claims procedure developed by Interactive Healthcare Technologies for Medical Mutual took the cost barrier out of the picture by requiring only a touch-tone phone.
The vendor sent a letter to the target provider population emphasizing the value and simplicity of the procedure-less than two minutes per claim, following the step-by-step instructions of a computerized voice.
And to overcome the skeptical segment, Medical Mutual absorbed the undisclosed cost of the contract with Interactive Healthcare.
Since last August, when the system was introduced, the insurer has registered about 15% of its low-volume providers, collecting more than 2,500 medical/surgical and 1,500 dental claims a month, Manco says.
If a claim makes it through all the prompts and responses, that means it has been submitted cleanly, and the only remaining questions are those about patient eligibility for the benefits documented in the claim, Manco says. The provider gets a confirmation number certifying the claim was made, Manco adds.
The free service isn't expected to make high-volume providers abandon their PCs and transaction vendors. Phone transactions still must be made one at a time, while PCs can send batches of claims at once.
However, providers familiar with the phone routine can cut the length of each transaction in half by using the "pound" key to interrupt the voice prompt, Manco says.