 Humana's
Real-time Commitment
to Administrative Simplification
Dear Physician and Office Staff:
Administrative complexity
around billing and payment processes is of growing concern to most
physician office practices today.* In fact, the Medical Group Management
Association (MGMA) estimates that billing complexities can cost
a small physician group nearly $60,000 a year. Humana is keenly
aware of the cost of complexities in the health care industry. Consistent
with our goal to be the easiest health plan with which to do business,
Humana has launched a number of administrative simplification initiatives
dedicated to creating innovative solutions and cost savings for
providers. Below are some highlights of just a few of these initiatives.
Real-time claims adjudication (RTCA) — Simplified
administrative solution enables a fully adjudicated claim at time
of service
In a recent issue of the magazine, we informed you of the expected
launch of an integrated real-time claims adjudication process that
would simplify administrative tasks and help physicians obtain payment
for services from patients more quickly. This solution comes as
high-deductible health plans (HDHPs) continue to gain popularity
with employers. Throughout 2006, Humana will roll out real-time
claims adjudication across the country.
Expansion of Availity Services
The goal of Availity, formed in 2001, as a joint venture between
Humana and BlueCross® BlueShield® (BCBS) of Florida, is
to optimize the flow of transactions between health care professionals,
health care plans and other stakeholders through a secure, collaborative
Internet-based exchange. Many of these services are at no charge
to the provider. The outcome is a reduction of costs in the health
care marketplace and simplification of provider administrative work
flow.
Availity Care Profile, A payer-based health record
Humana and BCBS of Florida recently announced plans to launch Availity
Care Profile, a payer-based electronic health record, in 2006. A
payer-based health record, maintained by health plans, is an electronic
record containing claim-based information routinely collected from
physicians, pharmacies and other health care providers. This electronic
record provides a consolidated view of patients’ health care
services across physicians and providers, as well as other health
plans, helping improve patient safety and eliminating duplicate
procedures.
In addition to these administrative simplification initiatives,
we are collaborating with several national groups that are focused
on addressing complexities and finding solutions like industry standardization.
We look forward to enhancing our current solutions and sharing more
solutions with you in the future.
Sincerely,
Bruce Perkins
Senior Vice President,
National Contracting
*According to a recent study cited
on the Medical Group Management Association (MGMA) Web site
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