WASHINGTON – Blue Cross Blue Shield of North Carolina and Blue Cross Blue Shield of Tennessee are the latest payers to achieve certification for the process of verifying health insurance coverage.
Payers are moving away from proprietary processes and adopting the standardized business rules to access eligibility and benefits information as developed by the Council for Affordable Quality Health Care (CAQH) Committee on Operating Rules for Information Exchange (CORE).
BCBST already had the capability to provide verification electronically since 2002, said Chris Hardy, systems analyst. The operating rules, however, were proprietary to BCBST and somewhat limited.
“Providers have to follow one set of rules for BCBST and another set of rules when communicating with other health plans – such as how they connect,” he said.
As a member of the CAQH Board of Directors, BCBST president and CEO Vicky Greggy wanted the payer to be an early adopter because she saw the potential benefits for both BCBST stakeholders and the industry.
Harry Reynolds, vice president of BCBSNC and CORE chairman, also recognized the benefits.
“What’s exciting about CORE is that it helps all providers get better information from all payers,” he said. “If we can give better information electronically, we take the manual burden off of providers and payers.”
Reynolds said BCBSNC will track two quarters before and after CORE implementation to determine benefits to trading partners.
While Hardy said the impact of offering electronic access to eligibility and benefit information via CORE is too early to tell, Reynolds anticipates benefit windfall for all multi-stakeholders.
Providers would save in labor costs. CAQH cites a study showing the average labor costs per phone call are $1.38 versus zero for an automated transaction.
Vendors such as clearinghouses would likely see increased use of transaction services. Payers would see labor cost decreases and increases in provider and patient satisfaction.
Reynolds pointed out that the inherent interoperability will allow North Carolina providers to retrieve information on any BCBS patient.
The goal of CORE is to work toward an all-payer solution system for administrative transactions, said Gwendolyn Lohse, director of CAQH CORE.
CORE strove to ensure that its efforts complemented standardization initiatives for clinical systems.
“The leaders of BCBST and BCBSNC see the value of CORE bringing administrative transactions into the interoperability arena,” she said.