Health Insurer Web Portal Aims to Simplify Physicians' Paperwork Processing

Janice Simmons, for HealthLeaders Media , October 7, 2009

Beginning next month, physicians, hospitals, and other healthcare providers in Ohio will have the opportunity to tackle the time and expense of "the paperwork monster" when health plans in the state introduce a new Web portal designed to streamline tasks such as billing, confirming eligibility, and referrals to other physicians or services.

America's Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association (BCBSA) are behind this pilot initiative that will examine how to offer physicians access to multiple insurers through a single information channel—a Web portal—in a given region of the country.

The initiative is initially designed to simplify information flow between health plans and physicians' offices, and later between health plans and hospitals.

The private insurers that have signed on to use the new portal are Aetna, Anthem, Cigna, Kaiser Permanente, Medical Mutual of Ohio, Humana, UnitedHealthcare, and WellCare Health Plans. At the current time, the Medicare and Medicaid programs are not involved in the Ohio initiative, although negotiations are still continuing. These plans represent about than 91% of state residents with private health insurance. Availity, LLC, is the project vendor. A similar initiative is planned for New Jersey.

Physician organizations who are supporting the effort are: the Ohio chapter of the American Academy of Pediatrics, the Ohio Academy of Family Physicians, the Ohio Medical Group Management Association, the Ohio Osteopathic Association, and the Ohio State Medical Association.

Streamlining the administrative process for providers "will result in tremendous savings, both in time and resources, and ultimately lead to improved consumer experience," said Scott Serota, BCBSA president and CEO.

The Ohio initiative is expected to simplify the work associated with patient visits and achieve savings by providing physicians with information in "real time" that:

  • Permits office staff to quickly determine patient eligibility and benefit information such as copayments, co insurance, and deductibles, and differences in coverage for services provided in network versus out of network.
  • Provides physicians access to current information on the status of claims submitted by physician offices for payment by insurers.
  • Tests real time referrals and preauthorization of services.
  • Provides for the online submission of healthcare claims.

Initiatives that streamline healthcare administration, such as this effort, have the potential to "slow the growth of the cost of care and contribute to savings nationally," said AHIP President and CEO Karen Ignagni.

Bradley Fluegel, executive vice president at WellPoint, the parent company of Anthem Blue Cross and Blue Shield, said that studies have shown the healthcare system could save up to $30 billion through automation of paperwork functions.

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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