Physician's Coding Strategist-New Web site offers access to database
Claims status, eligibility available in real time
Submitting claims and checking eligibility status through a dial-up connection to payers is nothing new. Now, one major payer is offering providers this service through a secure Web site — and giving its members access, too.
In essence, Blue Cross and Blue Shield of South Carolina in Columbia has Web-enabled its mainframe transactions, explains Terry Povey, chairman of the Internet steering committee for the company. Blue Cross wanted to allow its members and providers the opportunity to conduct their business transactions with the company at any time, and in real time.
"We were trying to accomplish another means of superior customer service," he says.
Users of the system are able to access account updates immediately.
To access the database, users must visit Blue Cross' Web site, www.SouthCarolinaBlues.com, and then select "My Insurance Manager." A demo is available on the site for guests to view the technology. Through "My Insurance Manager," members can check:
• personal claim status;
• amount paid toward deductible;
• out-of-pocket amounts;
• hospital inpatient and outpatient authorization status;
• eligibility status;
• explanation of benefits (EOB) statements;
• other health insurance such as coverage through a spouse.
Depending upon their health plan and product, members can also:
• change primary care physicians;
• order ID cards;
• view benefit booklets;
• check bill status.
By signing on to "My Insurance Manager," providers can:
• check a patient's claim and/or eligibility;
• view benefit booklets;
• check hospital inpatient and outpatient authorizations;
• see how much a patient has paid toward the deductible;
• check a patient's out-of-pocket amounts;
• confirm whether a patient has any other health insurance.
Providers can also go on-line to check one function for numerous patients or check all functions for one patient. Multiple staff members within a provider's organization can be authorized to perform these tasks on-line.
Blue Cross maintains the security of the site through socket layer encryption. This means that all personal information is encrypted. Users must create a profile and receive a password before accessing the system.
The information in the profile, such as member ID number and birthdate, also enables Blue Cross to know how to route an e-mail message in case the information the user needs cannot be located on the Web site. "[Users] can select 'Ask Customer Service,' and the system will route the question to the appropriate customer service area," Povey says.
After research and design, the site was unveiled to the company's 10,000 employees in November 1999. Blue Cross tested the system for a month, and then publicly announced the site in December.
The company decided to take a low-key marketing approach to the system. "The market for 'My Insurance Manager' was so focused on our own membership base and our providers that were part of our network," Povey explains. "All [of] the communication, training, promotion and marketing, therefore, has been directed to those audiences. We have had growing utilization as individuals find out about it."
Blue Cross inserted information about "My Insurance Manager" in EOB statements to policyholders and in remittances to providers beginning last February. Company representatives also demonstrated the site to providers, and placed a message about the technology on the company's voice response unit (VRU), which providers and patients often call to receive more information about accounts. In addition, all of the payer's advertising and brochures referenced the Web site.
The system is still too new for Blue Cross to see if the Web access has reduced the number of calls into the VRU. By monitoring the utilization of the site or its hits to various functionalities, though, the company does have indications that "My Insurance Manager" is doing its job.
"We are finding on a weekly basis that when providers or members sign onto 'My Insurance Manager,' they submit an additional question only 3% of the time," Povey says. That indicates that 97% of the time users can find the information they seek on the site.
Blue Cross sees a much higher opt-out rate with its VRU, she adds. "Sometimes, [users] get on the VRU and then have to opt out [of the system] and talk to a customer service representative almost 50% of the time."
Povey says Blue Cross has received a great deal of attention from "My Insurance Manager." If providers would like more information about the site, they can call Elizabeth Hammond at (803) 788-0222, ext. 44626.
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