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Blues push for real-time systems change

Blue Cross Blue Shield health-insurance companies serving
the midstate are working to comply with a national push that might vastly
change how they do business.

Blue Cross Blue Shield health-insurance companies serving
the midstate are working to comply with a national push that might vastly
change how they do business.

The Blue Cross Blue Shield Association is encouraging all of
its members to implement real-time electronic-claims processing and computer
systems where patients can get real-time cost estimates for procedures.

That’s a significant undertaking for the “blues” serving the
midstate – Highmark Inc. and Capital BlueCross – but one they say will be good
for patients and providers alike. Both are independent members of the
association.

“There’s no other retail transaction where we purchase a
good or a service, and you’ll get a bill in 30 days, and you have no idea how
much it’s going to cost,” said Robin Bugni, director of strategic products for
Pittsburgh-based Highmark.

“We felt it was important putting in these capacities so
that we can let members make better-informed decisions,” she said.

The new system is especially needed with the growth of plans
with high-deductible, coinsurance and other cost-sharing measures, she said.
Roughly 730,000 Highmark customers have this type of insurance.

Highmark rolled out its real-time capabilities last month
with a pilot group of 250 providers, and claims it is the first insurance
company in Central Pennsylvania to add
real-time capabilities. Highmark does business as Highmark Blue Shield.

The company plans to allow all of its providers access in
April 2009.

To access the electronic-claims processing and cost-quote
system, providers log onto Highmark’s Web portal.

They do not need to buy any additional equipment or upgrade
their Internet connection to do so, company spokesman Leilyn Perri said.

Dawn Taddeo, insurance coordinator for Berkshire Allergy and
Asthma Center
in Berks County, is among the pilot group of
providers.

“Let me tell you – in my experience, this will really be a
good thing if it I works the way I think it will,” said Taddeo, who received
training on the system last week.

“This is going to have the biggest impact on patient
collections,” she said. “If (patients) pay upfront, we won’t have to chase
patients for money. I think everybody is going to be happier.”

Sometimes her practice doesn’t get paid for a procedure for
45 to 60 days, she said. Average uncollected patient financial liability is 50
percent, Bugni said.

Being able to bill a patient before a procedure will help
change that, Taddeo said.

“It will allow us to keep our doors open,” she said.

Susquehanna Township-based dental insurer United Concordia
Dental Plan Inc.
, a subsidiary of Highmark, has had real-time capabilities
since 1992.

“Ninety-nine percent of the time, it’s a better thing,” said
Linda Yinger of Sherman Dental Associates in Lower Paxton
Township.

What about that other 1 percent? Those are computer
malfunctions and the times when the practice doesn’t have enough staff members
to process a claim while the patient is still in the office, she said.

Uncollected patient financial liability dropped 30 percent
when Sherman Associates began using the capabilities, she said, coming to rest
at about 25 percent. Patients also are able to make quicker decisions about
procedures because they understand upfront how much it will cost, Yinger said.

United Concordia is working with its providers to have all
of them use the capabilities; about half do so now. Not all providers are aware
of the system or know how to use it, United Concordia officials said.

Real-time claims and cost quotes aren’t a panacea. Providers
stress that the cost estimate a patient receives is just that, and the estimate
is subject to change.

Susquehanna Township-based Capital BlueCross is putting
together a request for proposals for a vendor to create its real-time claims
processing and cost-quote system, said Kent Whiting, the company’s vice
president of information technology.

Capital BlueCross hopes to roll out its system by the end of
2009, he said – but the company wants it to work differently than Highmark’s.

Whiting said he wants Capital BlueCross’s product to
interface with the provider’s existing computer system so the information
doesn’t have to be entered twice – once into the provider’s own records and once
into Capital BlueCross’s system.

He echoed Taddeo, saying the new capabilities will decrease
administrative costs

because providers won’t have to spend so much time tracking
down patients who owe money.

Capital BlueCross would have been adding these capabilities
even without the push, Whiting said.

“Anything we can do to make (the system) more efficient is
something we all should do,” he said.

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