COLUMBIA, SC – The number of health plans offering real-time claims adjudication at the point of service for their network providers is on the rise.
While Blue Cross Blue Shield of South Carolina has had this service via its provider Web portal since 2002, the launch of its Superbill application in August 2006 has spurred greater physician adoption and loyalty.
Since 2002, BCBSSC has processed more than 3.5 million claims in real time, said David Boucher, assistant vice president of healthcare services.
Before Superbill’s launch, providers data-entered claims information. Now they click in their claims.
“The initial set-up of the patient into your patient directory is fast and it’s a one-time thing,” said Lisa Del Aguila, office manager at Bluffton-based Lowcountry Podiatry, P.A. “The claims entry takes only seconds and is immediate so you can collect your co-pay or deductible at the time of service.”
Del Aguila said patients “leave with a clear understanding of services rendered and their responsibility.”
Boucher said several of BCBSSC’s providers have eliminated clearinghouses, thereby eliminating the electronic hand-off layer.
Del Aguila agreed, adding: “I don’t have to pay a clearinghouse to send in my claims.”
Lowcountry Podiatry also uses United Healthcare’s Web-based claims submission system, but says BCBSSC’s education and support are the differentiators.
“They encourage feedback and ideas to improve services and provide products that are both beneficial and cost-effective for us and them,” Del Aguila said.
Barbara Yergeau, office manager for Pickens-based 1st Choice Medical Wellness & Rehab, said her organization has not only saved time and money on paper products, but she has also retrieved more claims information that she needs for their patients.
As more health plans deliver this service, Carl Doty, analyst at Forrester Research, worries about the sustainability of carrier-specific solutions.
“Proprietary approaches will eventually be overshadowed by the evolution of multi-carrier gateway solutions like Availity and RealMed,” he said.
Payers like Aetna, Cigna, Humana and the larger Blues plans will drive the evolution, he said.
“I expect much turmoil ahead as these players address the challenge of interoperability between payers’ claims engines, third-party clearinghouses and providers’ practice management and revenue cycle management systems,” said Doty.