Insurers try real-time response to online claims

Plans like claims processing over the Internet because it reduces their costs. They also say physicians who use the technology will get paid faster.

By Tyler Chin, AMNews staff. June 3, 2002.

Until last year, Keith Paley, MD, would send a paper claim and wait at least 30 days to get paid by Empire Blue Cross and Blue Shield.

Now, the solo general surgeon in Plattsburgh, N.Y., not only gets a check within 15 days but he also knows how much Empire will pay him and what patients owe him within seconds after his staff submits a claim to Empire over the Internet.

If there is a problem, his staff knows it and can fix it immediately rather than weeks later. This translates into fewer hassles and not having to wait 60 days to get paid whenever a problem crops up.

"I wish I could do this with all [insurers]," said Julie Shiflett, Dr. Paley's billing manager. "My follow-up is so easy. I'm not stuck on the phone waiting for someone to pick up the phone and say, 'Well your claim is on hold because of this, this and this.' This way I know instantly."

New York-based Empire is among a handful of insurers that have begun adjudicating claims in real time over the Internet. Others include Blue Cross and Blue Shield of Florida and Blue Cross and Blue Shield of South Carolina, which launched real-time claims adjudication in March and April, respectively, of this year.

Real-time claims adjudication could potentially address physician complaints that insurers routinely fail to pay them within the time prescribed by prompt-payments laws.

Of course, insurers aren't just offering real-time claims adjudication to make physicians feel good.

Insurers are offering it because they hope that the lure of quicker payment and reduced hassle will encourage doctors to file claims electronically. In turn, that will lower insurers' administrative costs and improve their relationship with physicians and other health professionals, executives at the Blues plans say. [...]