MINNEAPOLIS – Two companies – one a healthcare payer, the other a company offering services to physicians – are collaborating to bring real-time adjudication to physician offices.
UnitedHealthcare and athenahealth announced the collaboration last month that will bring real-time claims adjudication capabilities to physicians using athenahealth’s on-demand practice management service.
Last October, athenahealth reached a similar agreement with Humana Inc.
The agreement represents one approach to bringing an automated approach to real-time adjudication to physician offices. Typically, physician offices submit claims in batches through clearinghouses; any real-time adjudication that occurs requires physician offices to manually enter information on a payer’s Web site before receiving a response.
Interest in real-time adjudication is growing because physician offices want to collect payments from patients at the time of service. Traditionally, patients don’t know what they owe until days after services are rendered because payers adjudicate claims afterward. The increasing use of high-deductible coverage raises the stakes for physicians, because they often have a hard time collecting payments after care is delivered, and it’s often not cost-effective for them to vigorously pursue collection of most patients’ copayments.
With the approach, physicians who have signed up to use athenahealth’s practice management service to submit UnitedHealthcare claims can receive a fully adjudicated response in seconds. Annually, athenahealth says it has submitted 1.5 million claims to UnitedHealthcare.
The initiative fits with UnitedHealthcare’s efforts to increase the use of real-time adjudication for claims.
“UnitedHealthcare’s continued expansion of real-time claim adjudication shows commitment to simplifying physicians’ and consumers’ healthcare finances,” said Jonathan Bush, chairman and CEO of athenahealth. “Thousands of medical providers and their staff will now be able collect payment from their patients faster and more accurately.”
The system works because all athenahealth clients are on one system and network, and athenahealth’s vendor-neutral platform uses interfaces to enable real-time interactions with payers who partner with the company, said John Hallock, its manager of public affairs and corporate communication.
Payers are looking for links, such as those provided by athenahealth, because large payers won’t build real-time links with individual practices, Hallock said.
While the athenahealth system was tested in three pilot sites last year, it will have limited use because only a small percentage of the nation’s practices are using athenahealth’s application and network.
However, many see the need to move to a single platform to make real-time transactions a reality.
“To streamline the system for physicians and consumers, UnitedHealthcare is advancing technologies that operate on a single platform and can be used by anyone within the healthcare system,” said Ken Burdick, its CEO. “By collaborating with athenahealth and expanding the availability of real-time adjudication, we are helping to reduce costs for consumers and physicians, and bringing the healthcare industry a step closer to a more retail-like environment.”