50% jump in electronic claims submission by health care providers

Three out of every four insurance claims from health care providers are being submitted electronically to AmeriHealth New Jersey. That’s an increase of 50 percent over the past three years, the insurer said today.

Roughly 75 percent of all claims are now transmitted to AmeriHealth by computer as health care providers continue to move away from more expensive and time-consuming paper transactions. The insurer’s goal is to have 90 percent of all provider claims submitted via computer 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 president and CEO. “Electronic claims submissions provide a significant opportunity for both providers and insurers to improve their efficiency.”

According to the American Medical Association, the nation’s health care system would save an estimated $90 billion annually if physicians and payers handled the three 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. Handling claims electronically also reduces the potential for errors and the need to resubmit claims multiple times.

Barbara Fargnoli, billing manager at DiMarino, Kroop, Prieto, GI Associates, PA, a seven-physician practice in Woodbury, N.J., said, “At one point we weren’t electronic. 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 health care providers could save between 50 percent and 90 percent per claim using electronic submission instead of paper.

AmeriHealth began reaching out to its provider network about three years ago to encourage physicians and other health care providers to shift from paper to electronic claims submissions and other transactions. “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.”

In addition to submitting health claims electronically, AmeriHealth said there has been a substantial increase in other activities providers can perform electronically, including verifying a patient’s insurance eligibility and handing precertification for medical procedures and hospitalizations.

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