Managed care companies offer electronic services


Frederick Horan, Ph.D., of Colony Care Behavioral Health in Walpole, Massachusetts, supports the use of electronic services, but stresses the need for more secure encryption formats as well as computer backups. (photo by Kathryn Hardy)

By Phyllis Hanlon

Every psychologist dreams of spending more time helping patients either in the office or in a research setting, rather than contending with mundane, but necessary, administrative tasks. The increasing presence of electronic technology may just make those dreams a reality.

A number of managed care companies now offer various electronic services for its member providers. According to Christopher Murphy, media relations manager for Blue Cross/Blue Shield of Massachusetts (bcbsma.com), providers can submit claims, referrals and authorization requests online. Additionally, they can check client eligibility, record patient visits and post payments electronically. He notes that 75 to 80 percent of their providers use these services. "The numbers have steadily increased since implementation," he says. "We actually started doing this over 20 years ago with interactive real-time function and, then as technology improved, we have added things incrementally." Blue Cross/Blue Shield offers Web sites specifically geared to each state across the country in which it provides services.

For the last three years, Magellan (magellanprovider.com) has been communicating online with providers, initially through its quarterly newsletter, and now via electronic treatment request forms (TRF) and data change forms. Providers who register and receive a secure login can check claims' status and, in some cases, look up eligibility of benefits.

Dan McCarthy, vice president of analytic services and e-business, notes that turnaround time is significantly improved when using electronic services. "The Web site really guides you by having certain edits and controls on the fields to minimize mistakes that might delay the situation," he says. Documents that contain errors or omissions sent by regular mail might have to travel back and forth several times before proper information can be recorded.

Created cooperatively with the advice and input of more than 600 providers, Cigna (cigna.com) in October 2001 launched an online treatment request capability as well as other tools that give clinicians general information and support. "The OTR allows the provider to go online, close an Employee Assistance Program (EAP) case and automatically open a behavioral health case, if that's warranted," says Jodi Aronson Prohofsky, Ph.D., vice president of clinical operations. "Or they could go online and request additional sessions for their behavioral health cases. They get real-time response to their request - nanoseconds."

Coming in January, according to Prohofsky, is a new Web tool that will connect the OTR and EAP forms. "When a provider wants to submit a Web claim, they press one button and it carries all the demographic information over and fills out the Health Care Financing Administration (HCFA)," she says. "It will also carry over the procedure codes and provider demographics. Providers will just have to put in the dates of service and hit submit." Lindsay Shearer, director of public affairs for the Northeast region, notes that the Cigna Web site is available nationwide, although providers in Maryland may only use the EAP and Web claim functions. Other transactions require a state-mandated form, she says.

In spite of the apparent ease, speed, 24-hour availability and cost-effectiveness of electronic transactions, many psychologists still hesitate to take the cyber-leap. Ted Grossbart, Ph.D., a self-proclaimed early adopter as far as the Internet is concerned, is delaying his plunge into the world of e-business. "I can do my billing with a pen and one hour per month," he says. Grossbart has a private practice in Boston, MA, is senior associate and clinical supervisor at Beth Israel's Department of Psychiatry and an assistant professor at Harvard Medical School. For his professional purposes, paper records meet his current needs.

William Engels, Ph.D., a psychologist with a private practice in the Boston area, has yet to use electronic services, although admits he has been tempted. "I have checked on HMO provider pools and am almost ready to set up a Web site," he says. "It's on my to-do list." With a patient roster of approximately 25, Engels has not encountered a high demand for email interaction with clients or other providers.

Executive director of the Vermont Psychological Association (VPA) Jan Trepanier believes that a growing number of psychologists are using the Internet to file claims and OTR forms. However, the VPA has not conducted any formal research on the issue. "This is word of mouth," she says.

On the other hand, some psychologists welcome the technology and have been avid users for a while. Michael A. Goldberg, Ph.D., operates a practice of 13 psychologists and three psychiatrists in Norwood, MA, is a Harvard Medical School instructor and supervising psychologist at Children's Hospital in Boston. He has been submitting bills electronically for more than three years. In his case, working through a clearinghouse has proven to be a smart move. "The benefits greatly outweigh the costs. We save a tremendous amount of time and money," he says. "We have less rejected claims and much quicker payments. It feels as if the payors are rewarding us for using the electronic submission." When calculating the expense of printing, copying and mailing claims, Goldberg notes that doing business electronically costs less.

Sandra Rose, Ph.D. of Great Bay Mental Health Associates in Dover, NH, believes strongly in Internet technology. In her office of eight providers, electronic progress notes, computerized forms and online banking is the norm. "I already use the Internet to download patient materials from professional sites, including the APA, ranging from patient checklists to information about clinical Web sites, relevant chat rooms, and just today told a client about a site for panic disorder patients, which gives practical advice about how to cope, from clients themselves," she says.

Rose's experiences with insurance company Web sites for authorization reports, however, has been less than optimal. "I found that there were no options to explain your answers and didn't like that," she says. "I also found that if you made one little error, the whole thing wouldn't go." Rose does engage in electronic billing though, and notes that turn-around time is quick and the process is cost-efficient. Looking to the future, she predicts increasing use of electronic services. "I envision a time soon when clients can email into a central number and schedule their own appointments, much the same way I schedule my tennis court now," she says. "The computer knows the 'schedule of each court' and will never double book."

An enthusiastic Web user, Frederick Horan, Ph.D. of Colony Care Behavioral Health in Walpole, MA, points out areas that could use improvement. "I think some of the Web sites tend to be unwieldy and difficult to find your way around," he says. "Being able to make them with an interface that's clear, fairly intuitive and easily understood is crucial to making this work." He adds that providers and patients alike have variable comfort levels when working with computers.

Although he strongly supports the use of electronic services, Horan cautions that clients need to be informed of the possible risks and limitations when transmitting confidential data. He advocates for more secure encryption formats to protect sensitive information. Also, electronic records should be protected by regular computer back-ups. "If you lose your information, it's gone forever," he says.

A paperless practice may not hover in the near future, but electronics is assuming some of the more tedious, day-to-day tasks that consume much of a psychologist's time.

Managed care companies offer electronic services (January 2003 Issue)

Managed care companies offer electronic services
(January 2003 Issue)