RICHMOND, VA – CareFirst BlueCross BlueShield has partnered with Internet-based clearinghouse Payerpath to help drive adoption of electronic commerce.

The partnership illustrates the trend of clearinghouses increasing value-added services to expand market reach beyond simple claims processing, particularly the service to sign up hard-to-reach providers currently not submitting claims electronically.

Jocelyn Young, research director for healthcare technology at Datamonitor, said clearinghouses must show smaller-size provider groups – defined as three physicians or fewer – the benefits of electronic commerce.

"If clearinghouses can demonstrate that having this service will reduce the tier of small claims that go unfilled and unclaimed, thereby reducing revenue loss and directly impacting the bottom line of smaller-size provider groups, then both providers and payers will likely adopt this service," said Young.

Payerpath has a Web-based business model that allows integration with existing provider practice management systems. Additionally, claims can be entered directly into the Payerpath system for those provider groups that do not have a practice management system, which addresses critical concerns of paper-based providers. To ensure success, Payerpath deploys its resources towards its adoption program to drive more providers to the system and ultimately process more electronic claims. "Payerpath's bigger picture is to help automate the whole industry," said Jim Riley, vice president of sales. "You have to be a complete partner for payers and providers, and be willing to work to attract smaller providers – do the heavy lifting – if industry-wide automation is to be achieved."

Jim Riley, vice president of Payerpath

Hartford, Conn.-based Aetna and Minneapolis-based United Healthcare have also recently partnered with Payerpath to implement this service.

Other major clearinghouses are also seeking to boost electronic commerce providers. WebMD incorporates the service of converting paper-based providers within its all-payer service offering, said Tony Holcombe, president of WebMD and WebMD business services. ProxyMed, has a payer partner service that uses e-mail and telemarketing methods to try to convert paper-based providers. ProxyMed uses both Web-based and thick-client products to connect these providers.