AUSTIN, TX – A Texas mandate that workers’ compensation carriers accept e-billing from healthcare providers goes into effect on January 1, 2008.
Other states are paying close attention as Texas moves toward a streamlined billing system that is expected to reap significant savings in paper and processing costs.
Joseph Montoya, program specialist in healthcare policy for the Division of Workers Compensation of the Texas Dept. of Insurance, said the department will monitor the implementation and success to determine actual benefits.
“The perception has been that this is difficult to implement because Workers Comp. billing and reimbursement is more complex than other lines of insurance,” he said.
If successful, Montoya said, Texas could be a model for other states.
Texas has been working closely with California and the International Association of Industrial Accident Boards and Commissions (IAIABC) to establish a provider-to-payer standard.
Faith Howe, IAIABC’s EDI manager, said the organization has been communicating so that everyone is in the loop.
Both Texas and California are implementing IAIABC’s standard, and Oregon is getting ready to adopt it so that the state can report medication information to payers.
“It’s important for us to see how the process is going to make sure we’re fixing things along the way,” Howe said.
Texas has adopted the National Council of Prescription Drug Program 5.1 standard, which is already being used by pharmacies and pharmacy benefit managers (PBMs) to communicate.
ScripNet, which uses NCPDP 5.1, has announced its support of and compliance with the Texas mandate.
Many payers don’t go through a PBM for workers’ compensation transactions, said Dennis Sponer, CEO of the pharmacy benefit manager. “If the pharmacy doesn’t go through a PBM, it must submit paper bills,” he said.
The industry average for prescriptions per injured worker is approximately 11 per year, and 2 percent to 3 percent of annual pharmacy spending in the United States is for workers’ compensation, according to Sponer. That’s a lot of data-entered paper bills.
ScripNet’s compliance with the mandate presents an opportunity for the PBM to be the service provider that electronically connects pharmacy and payer and guarantees providers faster payment.