Insurer’s Web site cures access blues
Work that’s done in real time
Access managers throughout the country eventually may benefit from the innovation of a South Carolina insurance company that is making it easier for hospitals to submit claims, check eligibility, and obtain authorizations.
Blue Cross and Blue Shield of South Carolina, based in Columbia, now offers health care providers the ability to complete transactions with the insurer on-line, 24 hours a day, seven days a week, says Terry Povey, chairman of the company’s Internet steering committee.
The company’s goal in creating the Web site, www.SouthCarolinaBlues.com, Povey adds, was to allow medical providers and policy-holders to conduct their business transactions — beyond just enrolling and requesting identification cards, which some other insurers offer on-line — securely on-line and in real time.
The "My Insurance Manager" page on the site, he says, gives providers the ability to check the status of a patient’s claim and/or eligibility, view benefit booklets, check inpatient and outpatient authorization, see how much a patient has paid toward the deductible and out-of-pocket amounts, and confirm whether the patient has any other health insurance.
A secure, "Ask Provider Services" transaction was added for any further questions, Povey says. In addition, providers can go on-line to check one function, such as eligibility, for numerous patients or all functions for a single patient.
"We monitor the hits, or the utilization," he says. "What we are finding on a weekly basis is that when providers or members sign-on to "My Insurance Manager," only 3% of the time do they submit a question. That indicates that 97% of the time, they can find the information they seek on the site."
The company has a much higher opt-out rate with its voice response unit (VRU), Povey adds. "Sometimes it can run to almost 50%, where they get on the VRU and then have to opt out and talk to a customer service representative. We haven’t yet researched to see if the VRU now gets fewer calls. Analyzing the call volume into our company and seeing if the Internet [option] has replaced that is the next step."
Since news of Blue Cross and Blue Shield of South Carolina’s innovation got out, he says, many companies have called to find out how the insurer did it. They want to know how Blue Cross made the information secure and available on-line without using an Internet portal vendor and how it is making the information available in real time, Povey notes. A subsidiary of Blue Cross called Companion Information Management Resources, he adds, has a contract with the Blue Cross and Blue Shield Association to provide this service to Blues plans across the nation.
What is unique about the Web site, Povey says, is that the technology used to create the "My Insurance Manager" pages is linked to the company’s mainframe claims processing system, which provides the real-time capability. The site was designed with the user in mind, he adds, so providers and others accessing the site have their own pages and have the ability to interact on-line.
"This is new," he says. "We have not found any other health insurance companies nationwide that are offering this comprehensive a set of transactions. Claims status look-up is unique. We’ve gotten a lot of attention about this technology."
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