Multi-Payer Portals Are All The Rage

(MoneyWatch)  A growing number of health plans are deciding that it doesn't make sense for them to offer physicians individual web portals to check patient eligibility, benefits, claims status, and other insurance-related data. Instead, they're using multi-payer portals that simplify the workflow in the physician office by reducing the number of sites that staffers have to check for this information. The only problem is that there is more than one firm operating multi-payer portals.

Availity, one of these companies, is jointly owned by Blue Cross and Blue Shield of Florida, Humana, and Health Care Service Service Corp., which includes Blues plans in Illinois, Texas, Oklahoma, and New Mexico. WellPoint, which owns Blues plans in 13 other states, recently announced that it, too, will take an ownership stake in Availity. (It has not disclosed the size of this investment.) Later this year, Wellpoint plans in Indiana, Kentucky, Missouri, Ohio and Wisconsin will make their member information available to providers through the Availity portal. More Wellpoint companies are expected to follow in 2010.

According to Julie Klapstein, CEO of Availity, the company, which also includes a claims clearinghouse, already provides free information from 150 health plans to about 150,000 physicians. Besides Availity's owners, these include national insurers Aetna and Cigna. Some state Medicaid agencies are also supplying data, and Availity can deliver Medicare eligibility information. The addition of Wellpoint, Klapstein tells BNET, will at least double the number of physicians using Availity's portal.

Availity is a pioneer in the field of "real-time claims adjudication," which allows practices to determine a patient's financial responsibility during an office visit. That allows practices to collect all or part of the bill before the patient leaves the office--an increasingly important goal as the number of patients with high deductibles and copayments grows.

In addition, Availity is combining health plans' claims data with lab and pharmacy information to provide community health records on its web portal. This helps plans remind doctors of which patients need what preventive and chronic care services. Wellpoint will use the analytical ability of its Resolution Health Inc. subsidiary to refine these alerts.

Meanwhile, another company, NaviNet (formerly known as NaviMedix), claims that about 700,000 providers, of whom about 70 percent are doctors, are using its multi-payer portal. Its clients include more than 20 health plans, and about 350 non-client payers plus most Medicaid plans make their data available to physicians via NaviNet. Kendra Obrist, vice president of marketing for NaviNet, notes that Aetna shut down its own physician portal last year; although it still provides eligibility, benefits, and claims status information via EDI, it uses NaviNet as its web portal for these transactions.

While Aetna information is available on both NaviNet and Availity, physicians will have to check both portals (where they're both available) to get insurance data on the maximum percentage of their patients. Still, that's a big improvement over the old multiplicity of portals, and it should drive more physicians to do web transactions with health plans. That should reduce administrative costs, not only for physicians, but also for the insurance companies.