Claims

Blue Cross of California, Thousand Oaks, Calif., has expanded its physicians technology initiative to include 1,040 safety net physicians in California. Traditionally, safety net physicians provide care to the uninsured, poor and low-income patients, including those enrolled in the Medi-Cal and Healthy Families insurance programs.With an additional $2 million in funding, this technology initiative will help these physicians improve patient care, achieve greater efficiency and improve administrative functions. These new technologies are intended to provide greater access to information and data exchange via the Internet or wireless handheld devices.

For years, life insurance providers and their agents have relied on obtuse, text-heavy sales presentations to their individual customers. Too often, though, poor sales presentation tools fail to enlighten individuals concerning the magnitude of a life purchase.

WASHINGTON-- Millions of Americans buying health insurance on their own have a wide variety of products from which to choose, and most select plans very similar to the coverage available to working people in employer-sponsored groups.

Skilled drivers have fewer accidents. That's the logic behind a unique auto insurance program devised by Hibernian General Insurance, a Dublin, Ireland-based motor, home, farm and commercial insurance company that claims 26% of the Irish market.Launched in 2001, the program is called Ignition, and it targets inexperienced drivers with clean driving records who drive small cars. Those drivers who meet these criteria can receive auto premium discounts from Hibernian of 20% to 40% for successfully completing a one-day, advanced-driver training course, which is run by the U.K.-based Institute of Advanced Motorists.

Unlike previous industry attempts to standardize data exchanges between carriers, agents and third-party partners, it appears that XML is the real deal. Still, the industry has a long way to go before support for ACORD XML turns into widespread adoption.ACORD's XML specifications-covering property/casualty, life, and reinsurance- were designed for transferring data across firewalls, but some carriers are exploring use of the standards as a cost-effective internal integration tool for extracting data from legacy systems. In addition to controlling costs and opening access, such internal data integration capabilities may also help companies meet growing demands from regulators for increased accountability in internal operations.

The number of career agents-the largest distribution channel for life insurance-dropped significantly in a decade, down from 238,000 in 1990 to 178,000 in 2000. In addition, by 2010, 13.2% of the U.S. population will be 65 or older.These demographics present life insurers with product, distribution and operational challenges as fewer agents are available to sell new-sometimes complex-products to consumers who are planning for their retirement years.

Blue Cross and Blue Shield of Rhode Island needed to get a handle on lengthy call center calls, but not at the expense of reducing customer service. The Blues plan found a solution that accomplished these and other management goals.Time is a critical element of virtually every business process, but it is particularly crucial for customer service. When Providence-based Blue Cross and Blue Shield of Rhode Island (BCBSRI) decided to improve its call center operations, it established several goals, one of which was to reduce the average handling time per call by 20%.

A wise insurance executive-perhaps a chief information officer-once stated: "The strategies that worked for us in the past are the same ones that will cause us to fail in the future. That's because those strategies are only competitive for awhile."Carl Ascenzo, chief information officer for Boston-based Blue Cross Blue Shield of Massachusetts, didn't deliver this proclamation, but he easily could have. Over the years, in a career spent at Aetna Health Plan and PriceWater-houseCoopers before coming to BCBSMA, Ascenzo has seen things that were seemingly built to last fall by the wayside.

Recurring payments offer the insurance industry a simple, yet extremely powerful, customer service solution that has the potential to yield hundreds of millions of dollars in cost savings, improve cash flow, increase productivity and provide a competitive advantage.Also known as automatic bill payment and direct payment, recurring payments enable customers to authorize companies to automatically charge the amount owed on a payment card on a regular basis. Payments may be collected monthly, quarterly, or at whatever interval the consumer and the service provider establish.

ST. PAUL, Minn. -- Through aggressive health care fraud investigations and coordination among other states' Blue Cross plans, the Blue Cross Special Investigations Unit (SIU) stopped payment on $8.7 million of suspect claims last year, reducing the impact of fraud on premiums in Minnesota.

Atlanta-based Blue Cross and Blue Shield of Georgia has launched the Clear Claim Connection, an online product and service for its network providers. This product, created by McKesson Corp., enables BCBSGa to share with network providers the auditing rules and clinical rationale which exist in the claims billing and auditing code system used by BCBSGa.John Watts, president and chief executive officer of BCBSGa, says, "This important service will enable network physicians and their office staffs to review our payment methodology online. By providing this service, we hope to make our reimbursement policies more readily accessible and reduce misunderstandings among providers, members and BCBSGa."

NEW YORK--The Guardian Life Insurance Co. of America is making an effort to demystify the financial planning process and educate visitors on the role that Guardian's products and financial representatives play in an overall financial planning strategy. The company is doing it with a new Web site, located at www.GuardianLife.com. The new site replaces Guardian's existing Web address at www.glic.com.

In recognition of the HIPAA security rule pre-anniversary deadline that passed this month, Washington, D.C.-based nonprofit URAC released a report examining the state of preparedness in the health care industry in complying with the security rule.

Columbus, Ohio-based Nationwide Financial is using Web technology to make it easier for investment professionals to manage the client review process with a new tool called the Interactive Client Review (ICR).Nationwide's ICR tool simplifies the client review process by providing one-stop, real-time access to client portfolios online. Detailed information is presented in a concise and secure format for investment professionals to access from any remote location. The ICR tool can also provide investment professionals with a quick, easy view of their clients' quarterly statements online. Through its instantly accessible electronic format, ICR aims to help investment professionals manage their clients' accounts in half the time.

New York-based MetLife has introduced a new online Individual Disability Income (IDI) Broker Portal designed to simplify the policy application and case management process for brokers by providing access to real-time information.Through the IDI Broker Portal, MetAccessIDI.com, brokers can immediately obtain underwriting case status, underwriting requirements and client policy information, including policy status and payment history. In addition, required applications and forms can be downloaded through a link from the site. The portal also features a private message board providing brokers with a convenient channel for communicating with MetLife IDI Underwriters regarding their cases.

Toronto-based Manulife Financial Corp. and John Hancock Financial Services Inc., Boston, including its Canadian subsidiary, The Maritime Life Assurance Co., completed their merger after receiving all necessary regulatory approvals. John Hancock is now a subsidiary of Manulife Financial.John Hancock stock will cease trading on the New York Stock Exchange at the close of markets today, April 28, 2004. The approximately 675,000 John Hancock common shareholders are entitled to receive 1.1853 Manulife common shares for each John Hancock common share. John Hancock shareholders overwhelmingly approved the combination on February 24, 2004, with more than 95 per cent of the votes cast favouring the adoption of the merger agreement.

Each year, more insurers appear to be increasing their budgets in implementing sophisticated fraud detection systems; however, the majority of these investments are centered around post-payment fraud detection rather than detecting fraud prior to claims being paid.

Los Angeles-based Marshall & Swift / Boeckh (MS/B) will be acquired by MacDonald, Dettwiler and Associates Ltd., Richmond, B.C., Canada.MDA is a global information company providing property-specific information to businesses and governments. Operating through two groups Information Products and Information Systems, MDA is active in data collection, information extraction, and information distribution.

Tufts Health Plan has selected and deployed a software platform for e-billing, e-payment, and online customer care from edocs, Natick, Mass. By enhancing its existing site with the edocs applications, Tufts HP is offering comprehensive functionality for enrollment, billing, reconciliation and payment.

Denver, CO--Valen Technologies, a provider of intelligent predictive analysis and decision enabling software, announced the availability of a premium modification module for its predictive underwriting software, Risk Manager. The new module develops a sophisticated, multivariate pure premium model that underwriters use on a daily basis to surcharge and discount policies more effectively.