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Medical Coding News Archives

Initiative Aims to Save Providers Money and Time

June 18, 2010:

Payers and providers could save hundreds of billions of dollars by centralizing and standardizing cumbersome and time-consuming administrative and medical tasks. It is with these enormous savings in mind that the Blue Cross and Blue Shield Association (BCBSA), in conjunction with America’s Health Insurance Plans (AHIP), has launched an initiative involving regional and statewide plans. The insurers will evaluate options enabling physicians to access multiple insurers through one universal information channel (i.e., web portal) in a specific area of the country.

This year-long initiative will spotlight the need for centralizing and standardizing electronic transactions that physicians have been requesting. This is key in streamlining the steps physician office and hospital staff must take when performing basic administrative tasks, such as eligibility verification, making or obtaining referrals, and billing. Increasing automation and consistency in business practices could reap huge rewards while simplifying the day-to-day work associated with patient visits and providing physicians and hospitals with real-time information.

Benefits include:

  • Allowing staff to quickly and efficiently determine eligibility and benefit information while minimizing the amount of time and money normally needed to perform such tasks
  • Providing access to current and accurate information to physician office staff regarding claims status, thereby eliminating the need for follow-up calls, faxes, letters, and claims resubmissions, which ultimately delay reimbursement
  • Providing online claim submission
  • Testing real-time referral
  • Ensures timely preauthorization of services

This groundbreaking initiative will reduce the amount of time currently spent on paperwork and administrative duties. It will also improve patient care by easing access to up-to-date, complete patient information and freeing up providers’ time so that they can focus on patient care.

The initiative is being conducted in New Jersey, with a concurrent program launching in Ohio, and led by local health plans that represent more than 95 percent of state residents covered under private health plans. The following is a list of the health plans participating in the program:

  • Aetna
  • AmeriHealth New Jersey
  • Horizon BC/BS of New Jersey
  • UnitedHealthcare

Karen Prescott, CMM, CPC, CPC-I, CCS-P, PCS
Clinical/Technical Editor


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