Minn. health plan consortium develops online claims portal

For the 15% of Minnesota physicians not equipped to submit electronic claims to payers, the Minnesota Council of Health Plans has developed a tool it says can help both the doctors and the insurers themselves.

A newly launched Web portal, MN E-Connect, will allow physicians to comply with electronic submission requirements which go into effect July 15 as the result of a 2007 law.

That same law will require insurers to send any remittance advice, or notice of payment, electronically by Dec. 15. Physicians can review the advice and notices at the same Web site.

The portal, which is a joint project between the MCHP and its eight private-payer members, requires only Internet access to use. Claims sent by physicians will be formatted to meet set standards, then forwarded to the appropriate payer. Several other small payer groups are expected to participate as well.

Eileen Smith, a spokeswoman for MCHP, said 85% of physicians have already adopted an in-house system that allows them to submit claims electronically. MN E-Connect provides an option for those practices who don't, and are responsible for about 9 million claims per year.

Minnesota is the only state known to have passed a law requiring electronic submissions. Federal law requires the electronic submission of claims for Medicare Part A and Part B, with few exceptions. The Health Insurance Portability and Accountability Act sets standards for electronic claim submission.

The American Medical Association in 2004 reaffirmed its policy to support aggressive timetables for implementation of electronic data interchange technologies that will make electronic claims processing possible, so long as use of them is not required.

Janet Silversmith, director of health policy for the Minnesota Medical Assn., said the set of regulations and standards for electronic claims submission under HIPAA have not yet been completely defined. The MMA supported the state's 2007 legislation because it made progress toward addressing these gaps.

Silversmith admits the approaching deadline to start submitting electronic claims "had us worried." But those facing the greatest burden, she said, are nonphysician health and wellness workers eligible for reimbursement under Medicaid who must also meet the July 15 deadline. The portal will be available for them, as well.

Robert Zirkelbach, spokesman for America's Health Insurance Plans, said the group is pushing for adoption of technology that will help streamline the administrative processes associated with health care delivery. Electronic claims submission is a part of that, he said.

AHIP published a survey in 2006, its latest available, that found 75% of claims submitted that year were sent electronically, up from 44% in 2002. As a result, a greater number of claims were submitted within a week of service -- 30% in 2006, up from 19% in 2002. In contrast, 31% of paper claims were received more than 60 days after the date of service. Zirkelbach said the group has plans to update the survey soon but believes the percentage of electronic claims has gone up.