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Doctors welcome speedy access to patients' health plan status

A consortium releases the first part of a series of rules to get physicians up-to-date benefits information.

By Jonathan G. Bethely, amednews staff. Oct. 9, 2006.

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Joseph Stubbs, MD, an internist in Albany, Ga., has watched more patients than he can count walk out of his office after receiving medical treatment only to discover, sometimes weeks later, that the bill he sent to the patient's insurer has been denied.

It's a frustrating yet common occurrence for Dr. Stubbs and physicians nationwide, who aren't always able to check a patient's health plan status while they are still in the physician's office.

But a new set of rules promises to ease the stress physicians face as the Council for Affordable Quality Healthcare, a nonprofit alliance of the nation's largest health plans and networks, has developed a plan it says will make it easier for physicians and other health care professionals to verify patient insurance information.

CAQH's Committee on Operating Rules for Information Exchange says it has developed a series of rules built on existing HIPAA standards to make electronic transactions more efficient regardless of the technology in the physician's office.

More than 15 health plans, including Aetna, WellPoint and Humana and 30 vendors including Availity and Athenahealth, have agreed to implement the CORE rules in their own business practices by March 31, 2007.

CORE's participants extend beyond health plans to include various vendors, associations, government agencies, hospital systems and medical societies, including the American Medical Association.

CORE operating rules will allow physicians who contract with participating members to get up-to-date benefits information from any of the participating health plans in 20 seconds or less. CAQH officials say the physicians aren't required to purchase new equipment beyond what is currently used in their offices because the health plans and vendors are already working to implement the technology. Nearly 70 million people are covered by health plans committed to using the CORE rules.