ATLANTA – After completing a successful pilot program with 500 physicians, Blue Cross and Blue Shield of Georgia (BCBSGa) has teamed up with Availity, a health information network that health plan officials say will streamline business processes between more than 26,000 of Georgia's healthcare providers and
BCBSGa, the state's largest health plan.
With the new service, healthcare providers in BCBSGa's provider network can use a secure, Web-based exchange to:
• Obtain current insurance coverage information on patients (including eligibility and benefits),
• Submit claims online,
• Monitor the status of claim submissions, and
• Review patients’ longitudinal health records.
Access to Availity is offered at no cost to Georgia providers.
"Making patient information more readily accessible to providers throughout the state is of great value to both the physician and the patient," said Morgan Kendrick, president of BCBSGa. “Availity's efficiencies allow providers to spend more time with patients, not managing paperwork, ultimately reducing healthcare costs while improving patient outcomes.”
The network will also deliver timely and relevant clinical messages to doctors through the Availity CareProfile– a longitudinal patient care record that includes information gathered by BCBSGa from network physicians, pharmacies, labs and other providers of care. Clinical messages provide selected reminder information on disease symptoms, health risks and best practices in treatment protocols for certain chronic diseases.
These messages can play an important role in improving efficiency and quality in healthcare that helps better engage patients in their treatment, and provides decision support to treating physicians, according to Melanie Williams, senior contract and provider services manager for Emory Healthcare in Atlanta.
“Availity is a very efficient tool and it certainly fits our needs,” says Williams, who adds that the Web site is very user- friendly – easy to navigate and easy to set up for both staff and payers."
Julie Klapstein, chief executive officer for Availity, says "Blue Cross and Blue Shield of Georgia is underscoring its commitment to help providers manage their businesses even more efficiently in response to the financial pressures of healthcare reform.
“Ultimately, patients are the winners in this scenario,” she says, “as greater efficiency can drive better outcomes at lower costs.” Availity helps providers connect to the information they need, and BCBSGa supports system-wide efficiencies, says Klapstein.
Merrilee Severino, a physician practice management and revenue consultant in Seminole, Fla., says one of the most common denials for claims and a source of loss of revenue for a practice is lack of verification of eligibility prior to service.
“Without knowing a patient’s benefits, you gamble with the collectability of that visit,” she says. “If money leaves your door, only 40 percent of that revenue will ever be collected.”
It’s best, she says, to collect coinsurance payments at the time of service.
