Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


Plans Announce Pilot to Ease Paperwork Headaches at the Doctor's Office

By John Reichard, CQ HealthBeat Editor

Feb 11, 2010 -- The nation's largest health insurance lobby announced Thursday a pilot program in New Jersey to make it easier for the staff in doctor's offices to verify insurance coverage, determine what out-of-pocket payments the patient owes and get paid faster by the insurance company, among other efficiency gains.

The group of insurers and doctor groups that announced the pilot said it would reduce the big chunks of time and money doctor's offices spend in dealing with insurers.

The pilot is the latest effort by insurers to highlight their efforts to control health costs by reducing the big part of the health care dollar that goes for administrative costs rather than directly for health care.

America's Health Insurance Plans (AHIP), the lobby that announced the pilot, recently announced a similar pilot program in Ohio. Both efforts are in their early stages but are "pilots" in name only, AHIP officials stress. The programs involve most of the doctors and insurers in both states and are designed to be permanent, they say. The term pilot is meant to convey that the programs will include a period of evaluation to work out kinks in the program.

The officials add that the two pilots will show other states how insurers and doctors can work together to make changes that are "a very big deal" in doctor's offices, one of the AHIP officials noted.

Tens of billions of dollars can be saved in the health care system through such changes, they say, likening them to the advent of the ATM system in banking in which inserting a card in a machine virtually anywhere in the world produces cash.

But it may take a number of years before a similar streamlining of health care payment transactions occurs throughout the entire United States. Doing so involves completing the computerization of doctor's offices, the adoption of common standards for payment-related transactions and an umbrella organization willing to prod insurers and doctors to work together to create such a system.

Meanwhile, the Obama administration is highlighting soaring premiums charged by some insurers and blaming them on industry profiteering.

The White House hopes that public distress over unaffordable premium increases will prod lawmakers to move ahead on a big overhaul of the health care system. To the extent opponents of a big overhaul can say that marketplace changes are occurring outside of legislation to control health care costs they may be able to deflect a bit of that pressure. But insurers didn't tie the pilot programs specifically to lower premiums.

AHIP President Karen Ignagni said in a telephone news briefing announcing the New Jersey pilot that "health reform is going to be dependent on collaborations of this sort."

The average office of a primary care physician spends about $68,000 a year on administrative tasks, Ignagni said. The initiative can bring those costs down and slow the growth of health costs, she said.

The key to the new program in New Jersey is the so-called NaviNet Web portal. Its boosters say that in essence, it allows the staff in the doctor's office to go to one Web site to handle the multiple steps involved in filing a simple insurance claim.

For example, the office worker first has to verify that the patient has the insurance he says he does. The patient might have switched jobs and be confused about who his insurer is. Claims might then get filed with the wrong insurer and be rejected, requiring that they be refiled with the new insurer.

Because the portal accesses multiple insurers in New Jersey, a visit to the portal can determine who the actual insurer is, avoiding the misstep of filing with the wrong company.

Once coverage is verified, the office worker can find out right away what deductibles and co-payments are involved and so determine what the patient owes out of pocket. That payment can be collected right away, avoiding the time and expense of billing the patient to get paid later— and uncollected revenue if the patient doesn't later pay.

The portal also allows claims to be filed electronically.

Physician staff also can check on the status of a claim filed previously. Now, one of the big reasons claims are rejected is that an office files a claim, waits a number of days without getting paid and decides to refile the same claim. The insurer kicks both claims out of the system, paying neither. The doctor's office must then refile using a paper claim. A visit to the portal would confirm that the insurer had the first claim in its system and avoid the wasted effort involved in refiling.

Another advantage outlined by insurers is that an office can more efficiently document that a patient referred by another doctor has the proper referral. Sometimes treatment gets delayed and office time consumed because the patient doesn't have the needed slip of paper and efforts must be made to verify the referral. But the New Jersey pilot is testing "real-time referrals" through the portal, meaning they are done electronically, saving office staff time and money.

Insurers sometimes have their own Web portals allowing these functions to be performed but each has its own process that also may involve use of phone calls to get information. NaviNet allows all the big insurers in the state to be accessed using the same portal and the same procedures.

"What we are producing through NaviNet is the gateway, a one-stop shop, in which physicians and their offices can contact all of the health plans they're dealing with, doing away with different numbers, different codes, different Web sites — one gateway through which they can contact the health plan directly and through which their physician management systems can link in," Ignagni said.

A reporter on the call pressed Ignagni about how new the program really is, saying that NaviNet use by insurers in New Jersey is not new. However, Christy Bell, an executive with Horizon Blue Cross Blue Shield of New Jersey, said the insurer is shifting all of its enrollees to the NaviNet portal for the first time. All of the insurers involved in the announcement will make transactions through the portal and with all involved can work toward adopting the same standards to avoid confusion by physician office staff, officials said.

The companies involve account for 95 percent of the privately insured patients in New Jersey, officials said. The insurers involved are Aetna, AmeriHealth New Jersey, Cigna, Horizon Blue Cross Blue Shield of New Jersey and UnitedHealthcare.

The doctors involved are members of the Medical Society of New Jersey, the New Jersey Academy of Family Physicians, the New Jersey Association of Osteopathic Physicians and Surgeons, the New Jersey Medical Group Management Association, and Partners in Care Corp.

Publication Details