BUSINESSInsurance sites limit ability to submit online claimsA survey cites federal HIPAA regulations as a reason why insurers increasingly are taking claims and referral authorizations offline.By Tyler Chin, amednews staff. Dec. 9, 2002. During the next few months, physicians may find themselves unable to transmit claims and verify referral authorization status through insurers' Web sites as insurers take those services offline to make them compliant with new federal standards for electronic health care transactions, according to Cap Gemini Ernst & Young. The New York health care consulting company, which surveys and assesses the online interactive capabilities of insurers' Web sites every six months, found insurers have significantly improved the interactive capabilities of their sites but have also curtailed the ability of physicians to submit claims and check referral authorization status.
About 53% of insurers surveyed let physicians submit claims through their Web sites in March, but only 44% did so in October, according to Cap Gemini. The survey also found a slight decrease in the proportion of insurers letting doctors check referral authorization status online, down from 58% to 56%. Insurers are pulling those transactions off their sites because they need to revamp them to meet the requirements of the Health Insurance Portability and Accountability Act, said Peter Kongstvedt, MD, a vice president at Cap Gemini and co-author of the firm's report. Under HIPAA, physicians, insurers, providers and claims clearinghouses must use standardized national formats for claims and several other claims-related transactions by Oct. 16, 2003, if they had applied for a one-year extension. Otherwise, they had to comply with the regulation as of Oct. 16 of this year. In any event, the law requires covered parties to start testing the transactions in April. While HIPAA covers both claims submission and referral authorization transactions, the former poses the more complex compliance challenge, which explains why the survey found a larger drop in availability of claims submission than referral authorization, Dr. Kongstvedt said. He expects that doctors will be able to resume submitting claims and checking referral status over the Internet by late spring or early summer. Meanwhile, the impact will be minimal because few doctors file claims over the Internet, he said. Most insurers get their claims electronically via claims clearinghouses, and "any doctor who is submitting electronic claims through a clearinghouse won't see any changes," he added. ADDITIONAL INFORMATION:Online accessA survey by Cap Gemini Ernst & Young U.S. LLC recently found that insurers have enhanced the interactive capabilities of their Web sites to communicate with physicians, but that those same insurers are temporarily taking the Internet claims-submission function offline to make it compliant with new federal data format standards. Transaction March October ----------- ----- ------- Submit claims 53% 44% Check referral authorization status 58% 56% Access formulary 81% 87% Check claims status 63% 69% Access medical/ administrative policies 60% 67% Check eligibility 63% 64% Access clinical guidelines 56% 58% Chat with provider service representatives 4% 3% Source: Cap Gemini Ernst & Young Copyright 2002 American Medical Association. All rights reserved.
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