Aetna Inc. wants to give healthcare providers a way to connect directly to the insurer for the transmission of batch and real-time transactions.
The service, called Aetna EDI Connect, will enable claims submissions without the need for clearinghouses or third-party intermediaries.
With the move, Aetna joins other insurers who are seeking to automate the claims submission process and take a step closer to inter-active real-time data interchange and communication on claims status.
To enable the submission connectivity, Aetna has entered a five-year agreement with Ingenix, an Eden Prairie, Minn.-based health information technology company.
Under the contract, Ingenix will provide clearinghouse services as well as next-generation managed EDI services that enable healthcare providers and other bill submitters to transmit data directly to Aetna.
The service will work through a free direct-connect Web site available to all submitters whose practice management systems can transmit files conforming to standards for the Health Insurance Portability and Accountability Act of 1996.
In addition to enabling the Aetna EDI Connect Web site, Ingenix expanded its agreement to provide Aetna with clearinghouse services for electronic transactions through 2012.
As defined under HIPAA, these transactions include professional and institutional claims and encounters; electronic remittance advices; real-time eligibility verifications; claims status checks; and referral authorizations. These transactions will rely on standards from ASC X12, a standards-setting organization for electronic data interchange.
Organizations that want to submit claims through the service will need to comply with requirements in the Aetna EDI Connect Companion Guide, which contains examples of automation scripts and can help users determine if the Web site will handle their claims.