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Rollout of New Health Care Provider Tools Creates Meaningful Transactions to Streamline Medical Claims
Date:6/15/2009

ful 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 like
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SOURCE Highmark Inc.
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