Payors launch N.J. initiative for 'one-stop' electronic info service

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America’s Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association (BCBSA) have launched an initiative in New Jersey to simplify information flow between health plans, physician offices and hospitals by addressing the need for one-stop service in electronic transactions.

AHIP and BCBSA have begun sponsoring regional and statewide initiatives to assess how best to offer physicians access to multiple health insurers through the same information channel in a given region of the U.S. The intent is to reduce time, effort and expense for the “paperwork” required for each patient office visit, said AHIP, of Washington, D.C.

During the first year of the initiative, a pilot program will incorporate feedback from users and provide the opportunity for adjustments, according to AHIP, but the New Jersey initiative is designed to be permanent. The ultimate goal is to develop regional services that span the nation, the organization stated.

This initiative could offer opportunities to simplify the work associated with patient visits and achieve savings, according to AHIP, including providing physicians and hospitals with information in real-time that:

  • Allows office staff to determine eligibility and benefit information;
  • Gives physicians access to information on the status of claims submitted by physician offices for payment by insurers;
  • Tests real-time referrals and timely pre-authorization of services; and
  • Provides for the online submission of healthcare claims.

Participating health plans include Aetna, AmeriHealth New Jersey, Cigna, Horizon Blue Cross Blue Shield of New Jersey and UnitedHealthcare, according to AHIP. Physician organizations that are collaborating on the project are the Medical Society of New Jersey, New Jersey Academy of Family Physicians, New Jersey Association of Osteopathic Physicians and Surgeons, New Jersey Medical Group Management Association, and Partners in Care.