Physiatry Practice Management Resources

Real-time claims adjudication—which allows plans to approve claims and tell practices how much they'll pay within seconds of online submission—is spreading. Empire Blue Cross and Blue Shield is rolling out its real-time claims processing system to 70,000 New York physicians.* Anthem Blue Cross and Blue Shield, which has tested a similar system in Indiana, expanded it to Kentucky and Ohio last summer.

Now a new joint venture of Humana and Blue Cross and Blue Shield of Florida subsidiaries is planning to offer real-time claims adjudication to all physicians in Florida next year. The jointly owned company, called Availity, will soon start testing Web-based transactions with doctors in both plans' networks. These physicians' offices will be able to do eligibility and benefit checks, referrals and authorizations, claims status, and claims submission through a single Web site. Doctors who participate with the Florida Blues can already get real-time claims adjudication from that plan, but it won't be part of the Availity service until the pilot is completed. Humana is still considering how to provide real-time processing, says a spokesperson.

After concluding its test phase, Availity aims to sign on as many Florida payers as possible, says CEO Julie Klapstein. Humana and BC/BS together insure 29 percent of the commercial market. The service will be free to doctors.

Medical Economics Magazine