Health Plans to Create Standard Processes

FRAMINGHAM (07/21/2000) - A group of major health insurers is developing initiatives that will make it easier for doctors to communicate electronically with their health plans.

The Coalition for Affordable Quality Healthcare consists of 23 health plans, including Aetna Inc., Cigna Corp. and Oxford Health Plans Inc. The group's goal is to improve administrative efficiencies for physicians by establishing standards for processes such as submitting claims, credentialing physicians and checking patient eligibility, said Dr. Norman Payson, chairman and CEO of Trumbull, Conn.-based Oxford.

The time frame for most of the initiatives is between six and 12 months, though the physician credentialing effort is "imminent," said Payson.

Currently, doctors must supply their health plans withcredentialing information, but each insurer has a different format, said Mark Anderson, a vice president at Stamford, Conn.-based Meta Group Inc. and a former hospital CIO.

"The ideal would be to create one credentialing standard so [physicians] can do it online and don't have to re-enter data," he said.

Although Payson acknowledged that many health plans already offer online services, he said establishing standards would make physicians more likely to use the Internet or electronic data interchange for such transactions, which would increase efficiencies and slash costs industrywide.

But analysts said that through the Health Insurance Portability and Accountability Act of 1996, which has yet to be implemented, the federal government has already established standards for electronic-health transactions.

In addition to creating standards, the coalition expects to establish a database of information on prescription drugs. Payson said physicians can compare various medications and look for less expensive alternatives.

If physicians are going to take advantage of this drug information, they need to receive it in real time, said Anderson. And physicians should have access to the data from a portable device, not just a PC, because doctors aren't deskbound, he said.

But according to Mike Davis, research director at Stamford, Conn.-based Gartner Group Inc., physicians, already wary of insurers, may not trust information supplied by a health plan.

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