Health Plans Collaborate on Landmark Initiative

Feb. 12, 2010

Trenton, N.J. –   Health plans today launched a landmark initiative to make delivering and getting health care easier for patients and their physicians by reducing the time, effort, and expense for the “paperwork” required for each patient office visit.  The initiative, which will simplify information flow between health plans and doctors’ offices, and between health plans and hospitals, is comparable to what ATMs did for banks and consumers.

America’s Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association (BCBSA) are sponsoring regional and statewide initiatives to assess how best to offer physicians access to multiple insurers through the same information channel (e.g., a web portal) in a given region of the country for the purpose of conducting key office tasks.  Savings are estimated in the hundreds of billions of dollars as the entire health care system achieves efficiencies through similar moves to automation and consistent business practices.

The initiative announced today in New Jersey is being led by local health plans representing greater than 95% of state residents with private health insurance, and major statewide physician organizations. Participating health plans are: 

  • Aetna
  • AmeriHealth New Jersey
  • Horizon Blue Cross Blue Shield of New Jersey
  • UnitedHealthcare 

Physician organizations that are collaborating on the project are 

  • Medical Society of New Jersey
  • New Jersey Academy of Family Physicians
  • New Jersey Association of Osteopathic Physicians and Surgeons
  • New Jersey Medical Group Management Association
  • Partners in Care, Corp.

This landmark initiative addresses the need for one-stop service in electronic transactions that physicians have advocated for strongly, and is a requirement to achieve the level of savings that is ultimately possible.  It replaces a cumbersome system in which physician office and hospital staff spend considerable time at considerable expense accessing multiple channels to get the information needed to complete basic requirements for confirming eligibility, billing, and referrals.  While the first year constitutes a pilot that will incorporate the feedback of users and the opportunity for adjustments, the initiative is designed to be permanent.  The ultimate goal is to develop regional services that span the entire country.

“We applaud the efforts of health plans and providers working together to reduce administrative expenses and slow the growth of health care costs which could ultimately make health care coverage more affordable for New Jerseyans,” said New Jersey Department of Banking and Insurance Commissioner Designate Thomas Considine.

“This is a leadership initiative on the part of our health plans who have come together to simplify administrative processes and free up clinicians to spend less time on paperwork and more time with patients,” said AHIP President and CEO Karen Ignagni.

“This initiative is a great example of collaboration between key stakeholders to help improve the quality and value of our healthcare system,” said Scott P. Serota, President and CEO of the Blue Cross and Blue Shield Association. “Streamlining the administrative process for providers will result in tremendous savings, both in time and resources, and ultimately lead to improved consumer experience,” Serota said.

The New Jersey initiative offers opportunities to simplify the work associated with patient visits and achieve savings, including providing physicians and hospitals with information in “real-time” that 

  • Allows office staff to quickly determine key eligibility and benefit information (e.g., co-pays, co-insurance, and deductibles, and differences in coverage for services provided in- versus out-of-network), minimizing time and expense needed for such purposes;
  • Gives physicians access to current and accurate information on the status of claims submitted by physician offices for payment by insurers.  This will minimize the need for follow up steps by office staff or submission of duplicate claims that delay rather than expedite payment in most systems;
  • Tests real-time referrals and timely pre-authorization of services; and
  • Provides for the online submission of healthcare claims.

“The Medical Society of New Jersey (MSNJ) is pleased to participate in the launch of the multi-payer common portal project in New Jersey.  This new tool will allow our physician practices to check patient eligibility, deductible amounts and other critical benefit information from one source,” said Michael T. Kornett, Chief Executive Officer of MSNJ. “We are pleased to support a project aimed at reducing the administrative hassles and costs of providing healthcare in New Jersey,” Kornett said.

NaviNet is the project vendor.

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