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Don't Know How Much an X-Ray Costs You? Highmark Network Providers Will Begin Having Conversations With Highmark Members About Their Actual Cost of Care
Date:12/1/2008

p>"Over the last few years, we have seen continued growth in cost-sharing health plans such as those with high deductibles or coinsurance," said Robin Bugni, Highmark director of Strategic Products. "To help our members become true 'consumers of health care,' Highmark is taking the next step in the evolution of consumerism by helping our members to understand their actual out-of-pocket health care costs when they schedule and receive health care services. With Highmark's new real-time capabilities, providers can discuss these costs with patients and make payment arrangements at the time care is delivered."

Highmark's real-time capabilities give providers two unique tools: Real-Time Provider Estimation and Real-Time Claims Processing. Real-Time Provider Estimation allows the provider to submit requests for specific health care services -- before a member receives care or at the time of service -- and estimate the member's financial responsibility within seconds. This, in turn, can be utilized to address the member's desire to know the cost prior to receiving services, and collect or make arrangements for payment at the time care is delivered. Real-Time Claims Processing gives providers the added ability to submit claims for specific health care services and receive a fully processed claim response within seconds. This, in turn, enables the provider to collect or arrange for payment of the member's share of the cost at the time service is provided.

The costs to a member are calculated based upon the members' specific health plan taking into consideration their copayments, coinsurance, deductibles and other benefit structures.

Some 250 providers across Highmark's service area will begin using the real-time tools during the initial roll-out period, which started in November. In April 2009, all Highmark providers with access to Highmark's provider portal will be able to use the real-time capabilities.


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SOURCE Highmark Inc.
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