CHATTANOOGA, TN – Although the technology strategies vary, payers are either starting or expanding pilot programs that adjudicate claims in real time for providers.
While it’s too early to determine numbers for some pilots, a few have achieved savings that have justified recent expansions.
BlueCross BlueShield of Tennessee’s real-time adjudication system pilot began last December with eight provider offices using its estimation and submission capability on the payer’s Web site.
One provider reported being able to collect 70 percent of patient-owed fees from those covered by high-deductible health plans when patients were checking out.
“Consumer-directed healthcare is the business driver,” said Maggie Fox, manager of corporate systems development for BlueCross BlueShield of Tennessee. “This is not about speed and automation. It’s about providers getting patient liability at the point of care.”
“We’re also eliminating the hassle factor for patients in overcollection,” said Paul Kulpa, senior program manager for BlueCross BlueShield of Tennessee’s consumer-directed health plan.
Humana’s pilot, involving a 10-physician practice in Texas, yielded savings of $6 to $8 per claim. “The site saved $14,000 in billing costs alone,” said Janna Meek, director of Humana’s integrated provider solutions.
As a result of the positive results, the health plan is actively recruiting more physicians to integrate its real-time adjudication system with providers’ own practice management system.
“We’re striving to bring this closer to the retail experience for members and providers so cash flow of providers is not impacted by what members might owe,” Meek said.
Cigna HealthCare is currently testing its Health ePass initiative with some major customers with a large CIGNA CDHP membership in a region with participating providers.