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Aetna Moves to E-Claims

Carrier uses ProxyMed to allow physicians to submit e-claims.

With the HIPAA compliance deadline approaching and insurers also looking to cut costs and gain efficiency, Aetna ($43.25 billion in assets, Hartford) took a step towards both goals by beginning implementation of claims automation software that will communicate in HIPAA-compliant ANSI format.

Aetna will use technology from ProxyMed (Fort Lauderdale, FL) to provide 318,000 physicians in its network with the capability to electronically submit and track medical and hospital claims, and eventually verify eligibility and receive referrals and authorizations. Kirk Fisher, head of Aetna's provider connectivity area, says that ProxyMed's FOCUS, a methodology that helps carriers identify and convert small physicians practices—generally not as technology advanced as larger practices—from paper-based to electronic transactions, will help Aetna with its "paper-conversion growth goals."

Aetna will use ProxyMed's ProxyNet technology, according to Jack Guinan, executive vice president and chief technology officer, ProxyMed. "We are aiming to get the processing of claims in production by the end of September and the remainder of HIPAA-compliant transactions by the end of the year," Guinan says.

"We will set up an interface to connect to Aetna," says Guinan. "All Aetna has to do is test and certify our interface and our work."

Currently, Guinan says ProxyMed is working with Aetna to target the heaviest users of paper transactions, in an effort to get the physicians to convert to the ProxyNet network.

Greg MacSweeney is editorial director of InformationWeek Financial Services, whose brands include Wall Street & Technology, Bank Systems & Technology, Advanced Trading, and Insurance & Technology. View Full Bio

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