AHIP, Blues association create payer portal

A project in Ohio kicks off a nationwide effort to link physicians and insurers.

By Pamela Lewis Dolan — Posted Oct. 21, 2009

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America's Health Insurance Plans and the BlueCross BlueShield Assn. have created a Web portal than intends to be a one-stop shop for physicians to conduct financial transactions with several payers.

The project, announced Oct. 5, kicked off in Ohio with the support of the state's major health plans and several of the state's medical associations, including the Ohio State Medical Assn. The participating plans cover 91% of the residents in Ohio with private health insurance.

The portal builds on existing technology developed by the Availity Health Information Network, which was launched in Florida in 2001 by BlueCross BlueShield of Florida and Humana. The Ohio project marks the first time all the participating payers of the Availity network were brought together on one shared Web portal.

The network allows physicians to conduct all their financial transactions with payers, as well as to check eligibility and benefits information and deductibles. The site also is intended to provide real-time information on the status of claims.

Mary Bethe Brumfield, office manager for Richard B. Darr, MD, who runs a solo geriatric, internal medicine practice in Springfield, Ohio, has been using the system for about seven months. She said the elimination of wait times sitting on the phone with insurers has been among the greatest benefits.

A downside, she said, is that the system does not include traditional Medicare or Medicaid. She has to access other online systems to conduct those financial transactions.

But because much of Medicare's business in Ohio has been bought by private insurers, Brumfield said patients are often confused as to which company they are insured through. "Sometimes, I'm the one telling them what they have," Brumfield said. But the system makes it easier for her to find that information without going to each payer individually. She can enter a name, date of birth and Social Security number, and the patient's plan will pop up on her screen.

According to Jason Koma, spokesman for the Ohio State Medical Assn., getting traditional Medicare included in the system is something the association is pushing.

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