Aetna launches aggressive payment vow
15-day turnaround guarantee hits New York
Providers have become so concerned about late payment of managed care claims that aggressive physician practices and state medical associations have sought legislative action to ensure prompt payment.
But at least one payer - Blue Bell, PA-based Aetna US Healthcare - is attempting to change that trend by promising payment within 15 business days for all claims filed electronically by physician practices that sign up for the carrier's new E-Pay system.
Aetna plans to roll out the service nationwide in all its HMO markets by the end of next year, and already has implemented it in its New Jersey and metropolitan New York City markets, according to David Kirschenbaum, Aetna's general manager of electronic commerce. Approximately 2,000 of Aetna's participating providers in these markets have signed up for the system. The service will not be marketed to hospitals.
The plan has conducted mailings to participating physicians to make them aware of the E-Pay product and has targeted physician groups that already are submitting an above-average number of claims electronically. Approximately 40% of the claims submitted to Aetna are submitted electronically, meaning there is substantial room for improvement in the implementation of electronic claims submission.
Kirschenbaum admits that getting physician practices on board with electronic claims submission can be an uphill battle in some cases, which is why the plan has a fairly intensive sign-up process for the E-Pay system.
The enrollment process includes verifying the data Aetna has on the interested physician practice (for example, provider ID numbers and specialty classification in the provider directory), seeing whether the practice has signed up with an electronic service, recommending Aetna's Envoy partner to practices that currently do not have a service, and meeting to ensure that electronic linkages between Aetna and the practice are set up to conduct a smooth transmission of claims, Kirschenbaum says.
"Fifteen days [turnaround] would be exceedingly quick. [But] I think ultimately it can be done," says analyst Jeffrey Green, MD, with New York City-based Sanford Bernstein & Co. Green says he believes physicians would be comfortable with electronic claims submission if the software product is good and there are assurances of confidentiality of patient records.
The benefits to participating providers are not only quicker payment, but reduced administrative costs and improved relationships between providers and Aetna members, Kirschenbaum says. If physician practices submit claims electronically and receive prompt payment, there should be less need to devote staff time to follow-up calls checking on payment and less need to bill patients for unpaid claims by the payer.
The E-Pay system also includes a swipe card box that allows physician practices to transmit referral requests to Aetna electronically, Kirschenbaum says. "[E-Pay] is part of our broader electronic commerce strategy," he says.
Green predicts that other payers will follow Aetna's lead if the E-Pay system is successful.
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