Electronic claims up 50 percent at AmeriHealth

By Bernie Monegain
10:29 AM

Three out of every four insurance claims from healthcare providers are being submitted electronically to AmeriHealth New Jersey – an increase of 50 percent over the past three years, according to the New Jersey-based insurer.

About 75 percent of all claims are now transmitted to AmeriHealth by computer as healthcare providers move away from more expensive and time-consuming paper transactions. The insurer's goal is to have 90 percent of all provider claims submitted electronically within the next two years.

"We are working in close partnership with our providers to help them make the shift," said Judith Roman, AmeriHealth New Jersey's president and CEO. "Electronic claims submissions provide a significant opportunity for both providers and insurers to improve their efficiency."

According to the the American Medical Association, the nation's healthcare system would save an estimated $90 billion annually if physicians and payers handled the 3 billion claims submitted each year electronically rather than on paper.

"Doing these activities electronically saves not only money but valuable staff time, and it speeds up the processing of individual claims," Roman said. It also reduces the potential for errors and the need to resubmit claims multiple times, she said.

"At one point we weren't electronic," said Barbara Fargnoli, billing manager at DiMarino, Kroop, Prieto, GI Associates, PA, a seven-physician practice in Woodbury, N.J. "But with AmeriHealth's help, we're now submitting all our claims electronically. The turnaround time for claim payment has been great – on average it's two weeks faster than if the claim had been submitted on paper."

A 2006 study conducted by the consulting firm Milliman, Inc., estimated that healthcare providers could save between 50 percent and 90 percent per claim using electronic submission instead of paper.

AmeriHealth began encouraging its physicians and other healthcare providers to shift from paper to electronic claims submissions and other transactions about three years ago.

"Some of our providers have needed our assistance in making the transition," Roman said. "So we created a team dedicated to helping providers make the change."

AmeriHealth said there has been a substantial increase in other activities that providers can perform electronically, including verifying a patient's insurance eligibility and handling pre-certification for medical procedures and hospitalizations.

Promoting the use of efficient technology among its provider network remains a top priority for AmeriHealth.
 

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