Empire Blue Cross Blue Shield has joined a crowding field of Blues that can process medical claims in a heartbeat, cranking out an explanation of benefits in moments.
Blue Cross Blue Shield plans in Illinois, North Carolina and Maryland also are starting pilot programs for online claims adjudication. Meanwhile, a Blues plan in Florida has shifted from pilot to full rollout status, projecting that Blues providers anywhere in the state will have access to the instant claims processing system in 2001. Finally, a Blues plan in Indiana, the first to do online adjudication, will decide this month on expanding its program.
David Snow, executive vice president and chief operating officer of 4.1 million-enrollee Empire Blues, says the company has tested its claims adjudication system with encouraging results for physicians.
"The office staff can put in the claim and press enter. We will tell them in nine seconds what we'll pay and what the patient will owe," he says.
Actually, the claim is processed even faster than that, but it takes about nine seconds for the Internet-based communication links to move the electronic claim and its corresponding EOB back and forth. Payment time to the doctor on clean claims will be cut from the current average of 10 to 14 days to about a week, he says.
Snow had no trouble recruiting 40 physicians to serve as guinea pigs in the program, which began Dec. 18.
Empire Blues has been working for about 18 months on a project to shift much of its business to the Internet and about nine months developing in-house its claims adjudication component, Snow says. If testing goes well, the system could be offered to all Empire Blues providers in 2002.
Empire expects to launch an online eligibility checking function this spring.
Identification cards similar to credit cards already carried by enrollees will contain a magnetic "key" that, when swiped through a reader at a physician's office, will confirm coverage is up to date.
Another portion of the system to be released this summer has been developed by Cranbury, N.J.-based software developer onehealthbank.com. The company says its system will allow patients to connect to a medical savings, bank checking or credit card account so the patient can pay his or her portion of the bill on the spot.
"We've delivered the technology to them, and they'll roll it out on their schedule," says Bruce Elder, spokesperson for onehealthbank.com.
Snow says Empire Blues stands to cut in half its $700 million in annual administrative overhead by switching all of its participating physicians to the new system.
Anthem Blue Cross Blue Shield Indiana is believed to be the first insurer with online claims adjudication capability. Using a system it developed with Indianapolis-based RealMed, Anthem ran its first test claim through the system in April and has expanded its testing program to 50 sites. It has processed 11,500 claims thus far, according to Larry Gigerich, spokesperson for RealMed, which has a similar pilot with Blue Cross Blue Shield North Carolina. RealMed has systems in final testing at Blue Cross Blue Shield of Illinois and at CareFirst Blue Cross Blue Shield in Maryland, Gigerich says.
Blue Cross Blue Shield of Florida launched its system in September, and Patrick Haley, vice president of Virtual Office, a Florida Blues subsidiary that developed the system, says that by August, plan providers who want online claims processing throughout the state will have it.
The TriZetto Group of Newport Beach, Calif., and eHealthDirect of Lexington, Mass., also are developing online claims systems.