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Highmark Rolls Out Real-Time Claims Tools

Pilot begun last November shows high rates of satisfaction among providers who use the real-time claims processing and member liability estimation tools via the Highmark's NaviNet provider portal.

Highmark (Pittsburgh) has implemented real-time claims processing and member liability estimation tools. Following a pilot begun Nov. 2008, the capabilities are now available to all of the carrier's providers through Highmark's NaviNet provider portal, and the carrier is working with practice management vendors to integrate the real-time tools with their software, according to a Highmark source.

The carrier began the initial rollout of the real-time tools to approximately 250 providers in its Western and Central Pennsylvania service area, in Nov. 2008. During Jan. and Feb. 2009, the providers submitted nearly 10,000 transactions that identified approximately $395,000 worth of payments due from members.

The real-time capabilities are particularly helpful to Highmark members with high deductibles, coinsurance or other cost-sharing to better understand the actual cost of healthcare services, the carrier says. About 730,000 Highmark members in Pennsylvania are enrolled in health plans with cost sharing that includes deductibles and/or coinsurance for in-network services.

Highmark reports that its providers say the real-time capabilities have enabled their patients to better understand the cost of the services they have received, understand what they owe and more easily make payment arrangements. Physician offices have reported speeding reimbursement to within three days instead of 15 to 20 days owing to use of the online tools.

Members are also happy with the tools, according to the results of a Highmark survey that revealed that 88 percent of members whose providers use the real-time tools were satisfied with their experience.

"We are excited about the survey results because they confirm that our real-time tools are valuable to members as well as providers," comments Robin Bugni, vice president of business innovations and development, Highmark. "It is clear from the members' responses that the vast majority appreciate knowing the costs they are responsible for and for the convenience of getting payment out of the way at the time of the visit."

Bugni adds that the information obtained from members during this pilot phase also indicated that knowing costs prior to visits increased the member's ability to be prepared to make payments at the time of service. Additional aspects members liked about being given an estimate prior to the visit include getting a better understanding of healthcare costs; no surprises or unexpected changes during visits for services included in the estimate; being able to come prepared to make payment at the time of the visit; and being able to verify whether they have sufficient funds in their spending account.

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

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