Merritt Personal Lines Manual: Technology Advances
In 1998, Aetna U.S. Healthcare introduced a new electronic claims filing system to speed up payments to physicians and reduce paperwork and annoying errors for employees.
Under the system, called E-Pay, physicians can file claims using an in-office computer with special software provided by Aetna. A claim submitted will be reviewed and payment made within 15 days, the company said, compared with an industry average of 45 days and its own 30-day average.
"We believe that E-Pay will improve HMO claim turnaround time, leading to more predictable cash flows for physician practices and, therefore, higher satisfaction levels among our participating physicians," Michael Cardillo, president of Aetna/U.S. Healthcare, said in a written statement. "And as we convert the majority of claims to electronic processing, our overall service quality will greatly improve for employers and members."
Aetna officials also said the new system will reduce errors in claims and duplicate claim submissions. Although the company had no statistics on the percentage of claims filed on paper that contain errors, it said 40 percent of paper enrollment forms included mistakes. But when Aetna moved to electronic enrollment last year, the error rate dropped to under 1 percent.
But some consultants don't share Aetna's enthusiasm for E-pay. They claim that an electronic linkage between doctors and the HMO is good, but are disappointed more is not being done with it, such as data collection and electronic payments to doctors.
Paying claims faster helps employers by having a better plan for their employees. It also reduces the reasons for doctors to vent frustration on the patient, causes them send out fewer late-payment notices and make fewer phone calls to patients seeking payment.
But Aetna said the main benefit to employees is the expansion of the existing electronic referral system. With E-Pay, a primary care physician can file electronically with Aetna a referral to a specialist, eliminating the need for a member to obtain a paper referral. The referrals can be made by telephone into a voice response system or using a swipe box similar to those used for credit cards.
