In a visit today with Modern Physician, William Popik, M.D., chief medical officer of Aetna, says the company is trying to be more physician-friendly by creating a Web portal for doctors to inquire about claim edits and by setting up physician-specific call centers.
"Aetna is committed to simplifying and improving transparency in our claims-payment process and to paying physicians faster and with greater accuracy," Popik says.
At the top of the Hartford, Conn.-based company's efforts to be more physician-friendly is its settlement agreement on medical societies' class action lawsuits about claims processing, which comes at a time when most other plans vow to keep fighting the lawsuits.
The settlement is being reviewed for final approval this afternoon by U.S. District Judge Federico Moreno in Miami, but the hearing had not ended at deadline.
As part of that agreement, Popik says, Aetna recently opened Web access to a software program in which physicians or their staff can type in CPT codes and determine whether Aetna would bundle the codes or not.
The program, Clear Claim Connection, was developed by San Francisco-based McKesson and can be accessed through the Aetna web site at www.aetna.com/providerehealthoffice. It requires a user name and password that Aetna-contracted physicians can obtain from the company.
Popik acknowledges that hundreds of Aetna-specific edits have not yet been incorporated into the McKesson product and must be looked up on a long list on the Aetna Web site. But Popik says the Aetna edits will be incorporated into the Aetna software by the end of the year.
Popik also acknowledges that the McKesson program does not quote any fee schedules, but Aetna plans to list fees later on its Web site. Currently, physicians have to send Aetna requests in writing for fee schedules. Under the settlement, physicians can obtain fee levels for up to 50 CPT codes.
The McKesson site also does not handle medical-necessity edits and multiple-surgery reductions, Popik added.
Meanwhile, he says Aetna is reorganizing its telephone service centers in an effort to make them more responsive to physician needs.
Popik says the company is moving physicians from service centers that process queries from both members and physicians to a separate system of eight regional centers that handle just physician queries.
Aetna began setting up the physician-only centers earlier this year and expects to finish the work by year's end, he says. He adds that the company is reducing the 800 numbers for physicians to call from more than 1,000 to two: for Aetna HMOs and for non-HMO products.
He adds that next year Aetna plans to begin pay bills through electronic funds transfers.
Someday, but not in the near future, Popik says, physicians' offices will be able to submit claims and be paid entirely electronically.
"The physician claims are the simplest claims, and the office-visit claims are even simpler," he says. "But we haven't been asked to do it. I would be thrilled if people started asking for it."
He adds that while Aetna strongly encourages doctors to submit claims electronically, the company does not require it.