New Jersey Launches Web Portal to Reduce Health Plan Paperwork

Joe Cantlupe, for HealthLeaders Media , February 12, 2010

New Jersey health plans have joined in the fight to overcome the costly paperwork morass choking the healthcare system.

Health plans launched an initiative in the Garden State on Thursday, in which Web portals will be used in a pilot program that officials say will make health delivery easier for patients and physicians by reducing paperwork for each patient visit.

The effort is similar to a pilot program that physicians, hospitals, and providers initiated in Ohio last October..

Both initiatives are sponsored by America's Health Insurance Plans (AHIP), and the Blue Cross and Blue Shield Association (BCBSA).

The plan is to replace an onerous system in which physician and hospital staff spend time and expense getting information needed to complete basic requirements for confirming eligibility, billing, and referrals for insurance, while sorting through a number of insurers. With the Web portal process, however, doctors and hospitals can interact with multiple insurers, and quickly access information in "real time."

Project proponents say reducing paperwork and administrative headaches could save the healthcare system billions over time. It would also simplify the information flow between health plans and doctors offices' and between health plans and hospitals, according to AHIP and BCBSA officials.

Officials say the programs are a "one-stop" part of electronic transactions that physicians have strongly advocated for years and could eventually be as useful as an ATM machine for banks. The New Jersey health plans participating are Aetna, AmeriHealth New Jersey, CIGNA, Horizon Blue Cross Blue Shield of New Jersey, and UnitedHealthcare.

The physician organizations involved include the Medical Society of New Jersey, 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.

"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 P. Serota, president and CEO of the Blue Cross and Blue Shield Association.

The New Jersey and Ohio initiatives are designed to be permanent, but during the first-year they are considered pilots to obtain feedback from users and make any adjustments. "We will see if any tweaks are needed," said Susan Pisano, a spokeswoman for AHIP.

Specifically, the Web portal process will:

  • Allow office staff to quickly determine eligibility and benefit information (e.g., copays, co-insurance, and deductibles, and differences in coverage for services provided in- versus out-of-network)
  • Give physicians access to current and accurate information on the status of claims submitted by offices for payment by insurers. As a result, there will be less need for follow up by office staff or submission of duplicate claims that mostly delay rather than expedite the process
  • Tests real-time referrals and timely pre-authorization of services
  • Provide for the online submission of healthcare claims

Joe Cantlupe is a senior editor with HealthLeaders Media Online.

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