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Rollout of New Health Care Provider Tools Creates Meaningful Transactions to Streamline Medical Claims

New tools help Highmark members navigate health insurance

PITTSBURGH, June 15 /PRNewswire/ -- Collaboration within the health care system and administrative efficiencies are fundamental elements to any number of today's health care reform proposals in Washington, DC. New tools from Highmark to conduct real-time claims processing and real-time member liability estimation are driving collaboration and streamlining medical claims processing right in health care provider offices.

Real-time claims processing and real-time member liability estimation assist physicians and other providers to receive payment for their services and relieves the guesswork for members about the cost of their medical treatment. With real-time claims processing and real-time member liability estimation, Highmark members know their actual out-of-pocket health care costs based on their benefits when they schedule and/or receive health care services. Physicians can discuss the costs with members and make payment arrangements or collect payment at the time care is delivered.

Through real-time tools, Highmark's network providers -- physicians, hospitals, imaging centers, ambulatory surgical centers and other types of providers -- are now able to determine a member's financial obligation before a service is rendered and to collect payment when the member receives care. Providers submitting real-time claims may also receive the portion of the payment that comes from Highmark in a shorter timeframe than in the past.

About 250 providers across Highmark's 49-county service area in Western and Central Pennsylvania began using real-time tools during the initial roll-out period, which began in November 2008. During January and February 2009, these providers submitted nearly 10,000 transactions that identified approximately $395,000 worth of payments due from members.

These real-time capabilities are especially helpful to Highmark members with high deductibles, coinsurance or other cost-sharing to better understand the actual cost of health care services. Approximately 730,000 Highmark members in Pennsylvania are currently enrolled in health plans with cost-sharing that includes deductibles and/or coinsurance for in-network services.

The health care provider community has shared with Highmark that real-time claims processing has enabled their patients to better comprehend the cost of the services they have received, understand what they owe and more easily make payment arrangements. In the physician office setting, health care professionals have shared that real-time tools have enabled them to obtain reimbursement from Highmark within three days instead of 15 to 20 days.

All of Highmark's providers are now able to use the real-time tools through Highmark's provider portal, NaviNet. Highmark is also working with practice management system vendors to integrate the real-time tools with their software.

This point-of-service payment method is also receiving favorable reviews from members. In fact, a recent survey revealed that more than 88 percent of Highmark members whose providers used real-time tools were satisfied with their experience.

"We are excited about the survey results because they confirm that our real-time tools are valuable to members as well as providers," said Robin Bugni, Highmark vice president of business innovations and development. "It is clear from the members' responses that the vast majority appreciate knowing the costs they are responsible for and for the convenience of getting payment out of the way at the time of the visit."

Bugni noted that the information obtained from members during this pilot phase also indicated that knowing costs prior to visits increased the member's ability to be prepared to make payments at the time of service. Additional aspects members liked about being given an estimate prior to the visit included:

  • They can get a better understanding of the health care costs.
  • There were no surprises or unexpected charges during the visit for those services that were included in the estimate.
  • They can make sure they are prepared to make payment at the time of the visit.
  • They can check whether there are sufficient funds in their spending account.

About Highmark Inc.

As one of the leading health insurers in Pennsylvania, Highmark Inc.'s mission is to provide access to affordable, quality health care enabling individuals to live longer, healthier lives. Based in Pittsburgh, Highmark serves 4.6 million people through the company's health care benefits business. Highmark contributes millions of dollars to help keep quality health care programs affordable and to support community-based programs that work to improve people's health. Highmark exerts an enormous economic impact throughout Pennsylvania. A recent study states that Highmark's positive impact exceeded $2.5 billion. The company provides the resources to give its members a greater hand in their health.

Highmark Inc. is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. For more information, visit

SOURCE Highmark Inc.
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