Ohio initiative to test multi-payer Web portal

By Molly Merrill
04:52 PM

A new initiative launched in Ohio plans to improve the flow of information between health plans and physicians’ offices using a multi-payer Web portal.

Starting in November, America's Health Insurance Plans and the Blue Cross and Blue Shield Association will launch a multi-payer Web portal to assess how best to offer physicians access to multiple insurers through the same channel of information exchange for the purpose of conducting key office tasks. Insurers will coordinate to take the same approach, and as a group will collaborate with physicians and physician organizations.

"The Ohio State Medical Association is pleased to participate in the launch of the multi-payer portal project in Ohio. This new tool will allow Ohio physician practices to check patient eligibility, benefit coverage and claim status all from one source," said Mark Jarvis, senior director of practice economics at the OSMA. "This project will also help practices simplify administrative process and reduce some of the confusion in healthcare billing. Hopefully, this will give physicians more time to spend caring for patients by reducing administrative paperwork."

Supporters of the initiative say the portal would provide opportunities to simplify the work associated with patient visits and achieve savings, including providing physicians with information in "real-time" that:

* Allows office staff to quickly determine key eligibility and benefit information (e.g., co-pays, co-insurance and deductibles and differences in coverage for services provided in- versus out-of-network), minimizing time and expense needed for such purposes;
* Gives physicians access to current and accurate information on the status of claims submitted by physician offices for payment by insurers. This will minimize the need for follow-up steps by office staff or submission of duplicate claims that delay rather than expedite payment in most systems;
* Tests real-time referrals and timely pre-authorization of services; and
* Provides for the online submission of healthcare claims.

Participating health plans include Aetna, Anthem Blue Cross and Blue Shield CIGNA, Humana, Kaiser Permanente, Medical Mutual of Ohio, UnitedHealthcare and WellCare Health Plans, Inc.

"This landmark initiative in Ohio demonstrates the commitment of health plans to simplify healthcare and the potential that exists to achieve savings through efficiencies in what we used to call 'paperwork,'" said AHIP President and CEO Karen Ignagni. "We are committed to addressing the needs of practicing physicians for administrative simplicity and in that way contributing to improvements in patients' experience. These are goals that should be hallmarks for a reformed healthcare system."

The initiative will be conducted on a statewide basis, allowing for the participation of physicians and perhaps government programs in given geographic areas and overlapping service areas for multiple insurers. A second pilot is set to take place in New Jersey.

The portal's developers also hope to improve information flow between health plans and hospitals in the future.