Premera Blue Cross, a non-profit, independent, regional health plan based in western Washington, is rolling out an online system to its physician practices throughout Washington and Alaska during the first half of 2009 to help them meet cost transparency needs.
Seven clinics in Washington have gone live with the Provider POS Direct system, a Web-based application from The TriZetto Group, Inc. of Newport Beach, Calif. The application enables medical practices to determine patient financial liability in real-time, helps members make financial decisions about their healthcare and allows physicians and other providers to submit paperless claims in real-time and be paid more quickly for their services.
"Our implementation of TriZetto's application went smoothly, and we're pleased with how well the system has functioned from the get-go," said Dave Young, Premera's vice president of IT strategies and business services. "The Provider POS Direct application is easy to configure, use and upgrade. Our goals in making this system available to our providers are to improve transparency for healthcare consumers and payment efficiency for network providers. Early reviews of the platform by our contracted providers have been very positive."
The application can be used via Premera's Web site through a secure provider portal and calculates patients' financial liability in real-time. The calculation includes the total charge, fee adjustment (i.e., the negotiated provider discount), costs not covered, what the member's plan will pay, the deductible, copay and coinsurance. The physician and patient can also use the application in advance to consider various treatment options and choose a course of action.
"Real-time liability estimation is a great point of differentiation for Premera in the eyes of providers," said Dave Pinkert, senior vice president of network management and constituent Web solutions at TriZetto. "For members covered by Premera, doctors now can calculate financial liability accurately and adjudicate claims at any point in their workflow through the use of real-time information and transaction processing. The front-office staff can tell a patient how much he or she owes in full for a medical service and either collect payment at that time or set up a payment plan before the person leaves the office."
