Denver - Despite some challenges, the health insurance industry continues to focus forward on initiatives that will enable patient-related data sharing in order to help eliminate errors and reduce overall costs. Anthem Blue Cross and Blue Shield in Colorado announced its participation in a voluntary data-sharing program developed by the Council for Affordable Quality Healthcare (CAQH), the company reports.   The program, based on rules drafted by CAQH's Committee on Operating Rules for Information Exchange (CORE), is designed to link the data collected by health plans, providers, and vendors so that doctors can electronically verify their patients' insurance information in twenty seconds or less, significantly improving communications between providers and insurers.   A report issued in February 2006 by Dublin, Ireland-based Research and Markets notes that insurers will benefit from a trend in widespread adoption of electronic capture of patient data. With solid benefits predicted, there still remain challenges, however. Alluding to the routine capture of documents and data for both regulatory and business intelligence purposes, the Research and Markets holds that "health care in the clinical setting has resisted this industry-transforming technology for nearly 20 years. The reasons: the lack of user-friendly interfaces for busy health care providers, lack of workflow understanding on the part of vendors, the expense and complexity of implementation and maintenance solutions, and the lack of transparent ROI for providers." Empirical data on long-term benefits for a program such as this may not be available yet, but carriers such as anthem BCBS nevertheless have high hopes for initiatives designed to create incentives for providers that will help improve communications between parties and create a "healthier" patient base in the process. The fact that the CORE program is a voluntary, industry-wide collaboration facilitated by Washington-based CAQH, may help the cause. Anthem has been certified as a CAQH CORE health plan and has already completed the Phase I implementation of the CORE rules, which allows for standardized data transfer and quicker response times. Physicians who link to the health plan through electronic data interchange (EDI) will be able to use EDI for this quick verification. EDI is a method for two organizations to confidentially exchange data from one computer to another using standard formats that are HIPAA compliant. Currently, Anthem's EDI is used for claims filing, claims status checks, eligibility verification, electronic remittance advices, and electronic fund transfers back to health care providers.   "Anthem is committed to employing the most advanced information technology solutions available to improve both our members' experience and their interactions with physicians," said John Martie, president, Anthem Blue Cross and Blue Shield in Colorado, a subsidiary of WellPoint, Inc. "CAQH has developed an excellent framework for simplifying the administrative side of the health care system, and Anthem has worked diligently to ensure that we are capable of bringing the benefits of CAQH's efforts to our members."   "These programs have the potential to transform the way that health care providers and health plans communicate," continued Martie. "But most importantly, they will take much of the confusion out of the health care system for our members." Sources: Anthem Blue Cross and Blue Shield, INN Archives    

Register or login for access to this item and much more

All Digital Insurance content is archived after seven days.

Community members receive:
  • All recent and archived articles
  • Conference offers and updates
  • A full menu of enewsletter options
  • Web seminars, white papers, ebooks

Don't have an account? Register for Free Unlimited Access