Insurers test direct-deposit pay for claims

Health plans hope that physicians warm more to electronic transfer now that it's being tied directly into claims adjudication.

By Cheryl Jackson, AMNews staff. March 26, 2001.

Electronic transfer of payments from insurers straight into physicians' bank accounts is an idea whose time seems to be finally coming. The reason: Insurers see electronic payments and instant adjudication of claims as a way to cut their own spiraling costs.

Under pressure from Wall Street to cut costs, from employers to stop annual 10% to 15% premium increases, and from state legislatures to comply with laws requiring prompt payment of claims, insurers are signing up for systems that promise to cut the average of $12 insurers spend to process each claim and can pay doctors within five days of a claim's submission.

But just because the process may benefit insurers doesn't mean there's nothing in it for physicians.

For example, doctors in Indianapolis give positive reviews to a system that processes claims on the spot, then sends payments electronically in five days. They're testing a system created by RealMed of Carmel, Ind., which has recently signed contracts with such national Blue Cross Blue Shield operators as Anthem Inc., Indianapolis; Health Care Services Corp., Chicago; and others, representing 22 states and the District of Columbia.

The system, which tells an office when to expect payment in its account and lets it print an explanation of benefits for patients, including how much the patient is expected to pay, takes less time to process than it does to microwave a frozen burrito. Insurers say there's no threat of retroactive denials of payments or insurers taking money back out of physicians' checking accounts, because claims that aren't clean are rejected on the spot. [...]