Processing insurance claims can be a major headache for a physician’s office staff. But the Internet may hold the cure.
“We built our model to service small- and medium-sized providers with multiple services,” says Terry Lee, executive vice president and chief operating officer for Claimsnet.com, an Internet-based insurance claims processor. “There is no software to configure, because you are using the Internet. In essence, someone from a physician’s office could go to our site, sign up online, remotely install the software and be ready to go.”
As part of the installation, Claimsnet needs a set of claims or statement files to enter into its system.
“Once you are past the set-up, as the information is transmitted to us in real time, all the claims are checked for errors,” says Lee. “We make sure everything is accurate before moving on.”
For example, a claim may say it’s for AETNA, but list the wrong payer ID number. A required field might be blank, or a carrier-specific requirement may not be met. Claimsnet performs 22,000 edits and notifies the office immediately if there is an error.
Under the old system, an office might log into a bulletin board or clearinghouse, upload the claims, then sign off. That office might only log in once per week, so if a form were rejected for errors, it wouldn’t know about it right away, and it would take at least an additional seven days to get paid.
“The Internet system gives you more rapid feedback while they’re on our site,” says Lee.
Patient statements can also be generated through the system, printed and mailed out, complete with return envelope. Patient eligibility can be looked-up in real time, and the status of payment from insurance carriers is also available.
“You can also get all the reports from the payers,” says Lee. “Online you can look at the statistics on your patients: how many have you seen by sex, by procedure code — all with graphical representations of your practice. You could determine which carrier you are doing the most business with and focus on that payer. If you have a great relationship with that payer, you can increase your cash flow.”
Claimsnet has access to nearly every insurance carrier, either electronically, or, for those that still don’t accept electronic transactions, by mail. Because all insurance form requirements are kept up-to-date on the Net-based central database, there isn’t any software to update.
Training is available on the Claimsnet site, so when the office administrator leaves, the office doesn’t grind to a halt.
For commercial claims, the cost is $25 per month for unlimited access per submitting site, regardless of the number of physicians. To send noncommercial claims, such as those for state or federal programs, the cost is 25 cents each.
There is a $150 set-up fee for new users. How to reach: Claimsnet, www.claimsnet.com
Todd Shryock ([email protected]) is SBN’s special reports editor.