BCBS NC Partners with RealMed To Deliver Real-Time Claims Resolution

Following a round of testing, Blue Cross and Blue Shield of North Carolina (BCBS NC, Chapel Hill, $1.25 billion in assets) has penned a multi-year agreement with Indianapolis-based RealMed Corp. to deploy Internet-based real-time claims resolution technology at physicians' offices in North Carolina. Both companies now face the task of enrolling other targeted physicians and practice groups to use the solution.

Through the solution, RealMed provides an interface between doctors' offices and BCBC NC, enabling patients' claims to be processed before they leave the doctor's office. Providers who elect to use the system on a monthly enterprise fee basis can immediately determine patient eligibility, review up-to-date co-pay and deductible information, resolve patients' claims while they wait, receive and print the patient's explanation of benefits (EOB) and collect the balance due from the patient, according to Fred Goldwater, senior vice president, strategic development and CIO, BCBS NC.

"We see this solution as cutting across quite a number of stakeholders," Goldwater says, explaining that customers will perceive it as a better way of doing business because they will be able to leave with their claims completely resolved, including receiving an EOB. "We see it as a customer-pleaser," he adds.

Among the benefits to healthcare providers, Goldwater says, are getting paid faster and reducing staff time spent on paperwork and telephone follow-up. The carrier itself benefits, "because we will end up being more efficient from a core processing standpoint, and we also expect that we will have to deal with fewer customer and physician interactions around the claim."

RealMed sought out BCBS NC as part of its strategy to achieve greater market traction early on through partnering with BCBS carriers, according to a RealMed spokesperson. "The reason we've gone after the Blues is because of their market penetration," the spokesperson says. Another attraction was that BCBS NC already had a Web-based application working with 1,500 physician office locations, which comprises about 14,000 individual healthcare provider users, according to Scott Herbst, executive vice president, RealMed. "If you can find practices that have invested in technology, those people are obviously more receptive to taking the next step," he says.

Part of the sell to BCBS NC was the shouldering of a significant investment by RealMed to deploy the solution. "One of the fundamental tenets of our partnership with them as a very early adopter is that we will expect to recover our expenses over time," Herbst says. BCBS NC had to make a significant investment in time, as well as a serious orientation effort toward the solution. "It takes a very significant commitment from a payor like BCBS to take on a project like this," Herbst says. To create the necessary interfaces, "RealMed touched almost every substantive part of the BCBS NC organization. We worked with people who deal with money, patient enrollment, people who control inventory claims, etc."

Having tested the RealMed solution at 10 selected physician offices starting a year ago, RealMed and BCBS NC are now conducting joint provider sales and outreach efforts to speed enrollment of targeted physician groups, according to BCBS NC's Goldwater. "We would ultimately want as many physicians connected as we could facilitate," he says.

While the solution by no means requires 100 percent adoption by physician practices in order to succeed, according to RealMed's Herbst, the strategy is to "seek out the thought leaders in each geography we're in and get them to adopt this as the standard way to accept claims," he says. "We continue to identify large and influential practice groups and then cooperate very deeply with them to customize our solution to work with their existing workflow."

The RealMed solution is also deployed by Blue Cross Blue Shield carriers CareFirst (Owings Mills, MD), in its Maryland and District of Colombia coverage regions, and by Blue Cross Blue Shield of Illinois (Chicago).

Anthony O'Donnell has covered technology in the insurance industry since 2000, when he joined the editorial staff of Insurance & Technology. As an editor and reporter for I&T and the InformationWeek Financial Services of TechWeb he has written on all areas of information ... View Full Bio