Success in designing Web self-service capabilities does not subscribe to a "build it they will come" philosophy. The business sponsoring the Web site must first conduct diligent research to determine the specific blueprint of what Web features will be regularly accessed.BlueCross BlueShield of South Carolina was one of the first health providers in the nation to offer its members, doctors, hospitals and other health care professionals a large array of self-service transactional capabilities with real-time access to mission-critical information.
The group set the stage for this progressive Web expansion program with a first-generation Web site launched in 1999. In September 2001 the Columbia, S.C.-based provider greatly expanded the property at www.SouthCarolinaBlues.com to include content such as a doctor and hospital finder, wellness and discount information, pharmacy benefits, glossaries, frequently asked questions and various access to forms.
But the one most heralded features of the newly expanded site is My Insurance Manager, a secure area within the site that offers numerous transactional, fulfillment and service features to policyholders and physician organizations. Thus far, more than 93,000 members and 10,000 physicians are registered to use My Insurance Manager.
"We perceive the Web as an 'always-open' space designed to offer services securely to members and providers," says Terry Povey, director of Web business development, market research and statistics, South Carolina BCBS. "We determined what the most common inquiries were to our customer service centers, and used that to develop a priority list for Web-enabled functionality."
By the end of last year, the Blues plan reduced the volume of inquiries coming into its call centers by 6% a month.
By activating My Insurance Manager, member providers of BCBSSC and employer groups have the ability to view claims status, check deductible and out-of-pocket amounts, view referral and in-patient and out-patient authorization status, check eligibility status, view and print explanation of benefits (EOBs), view benefit booklets and order ID cards.
Drilling down into the feature, a secure "Ask Customer Service" transaction routes member inquiries directly to the appropriate health plan customer service representatives, Povey says. Physicians can view the same information about their patients, and can submit referral requests and claims through My Insurance Manager.
"The key to all the features of our site is a visitor has real-time access to information," says David Brodeur, director of managed care services, BlueCross BlueShield of South Carolina. "The physician directory is updated daily-not weekly or monthly-so that if a physician leaves the network, it's immediately captured."
In the past year, the Blues plan introduced technology that enables claims information to be keyed directly its mainframe computers, rather than having the data routed to an electronic clearinghouse. "One of our provider members is issued a claim number and then can monitor progress of the claim over the course of the cycle," Brodeur explains. "Typically, we can cut a check to the member within five days."
