Want your claims money faster? Take a ride on the electronic highway

Some insurers offering incentives to switch

Tired of your payers "losing" your claims and taking forever to cut and mail your checks? Some insurers are offering a promising solution to that quandary, provided you are willing to step into the electronic age.

The insurers, hoping to cut their own costs of dealing with paper claims, are promising faster payment if practices will process their claims over the Internet.

As provider groups lobby Congress and their state legislatures to force plans to pay their claims promptly (see story, p. 66), some insur-ers and upstart Internet sites are joining forces to offer practitioners an array of incentives to use the World Wide Web to process medical claims electronically. Providers will get paid faster, the HMOs promise.

Plans such as Humana, Sierra Health Services, and Blue Cross/Blue Shield of South Carolina recently have struck deals with physician-oriented Web sites that permit doctors in their networks to submit claims, make referrals, and check claim status, patient eligibility, and deductibles over the Internet.

To get the physicians’ attention, those HMOs promise to pay their related Internet claims transaction fees, which typically can amount to between 20 cents and 50 cents per claim. Some plans have even sweetened the deal by agreeing to electronically deposit the money from claims directly into the practice’s bank account, eliminating the need to wait for a paper check.

"We’re just trying to improve customer service for all our constituencies — providers, members, and employer groups," says Peter O’Neill, spokesman for Sierra Health, which operates in Arizona, Nevada, and Texas. "Over the long term, we think moving to Web-based transaction will reduce our costs significantly."

There is nothing particularly new about plans trying to wean providers from their attachment to paper claims. What’s different this time is that more reimbursement experts think it may work. The main reason is that the Internet has several major advantages over previous electronic systems. Namely, the Internet already exists, so offices don’t have to buy and install a lot of new equipment. Start-up costs are low, and it is easier to use.

Of the physician claims processed by the Blues, 60% are still presented on paper, with the remaining 40% submitted electronically. The Blues’ goal is to have nearly 100% of claims submitted to them electronically with the next five years. Doctors who are part of the Blue Cross Blue Shield network in South Carolina will be able to start processing claims over the Internet in July at the plan’s own Web site. Meanwhile, they can check claim status, eligibility, and deductibles and make referrals on-line.

"We feel a lot of physicians are going to see that using Internet will be to their advantage," notes Thomas G. Faulds, president of the Blue Cross and Blue Shield Division of Blue Cross and Blue Shield of South Carolina. "The bottom line is that we hope to convince physicians it will save them money in processing costs while they get paid faster."