Medical Economics Story - October 2008
Tex Med . 2008;104(10):38-39.
By Ken Ortolon
Availity, L.L.C. and Health Care Service Corporation (HCSC), which operates the Blue Cross and Blue Shield (BCBS) plans in Texas, Illinois, New Mexico, and Oklahoma, have completed the migration of 11,000 medical practices and hospitals from The Health Information Network (THIN) platform to the Availity platform.
The effort involved testing and moving electronic transactions for more than 11,000 health care provider sites, 450 vendors, 40 clearinghouses, and 200 health plans and other health claim systems across the nation.
"The work we're doing with Availity can significantly support the relationship between our members and their health care providers so that health information can more easily be used to prevent and treat illness and can make the delivery of care less costly," said Paul Handel, MD, HCSC's chief medical officer.
The migration follows a 2006 collaboration between HCSC, Blue Cross and Blue Shield of Florida (BCBSF), and Humana to integrate THIN's assets with those of Availity. Company officials say the joint venture increased development of real-time health care transactions - reconciling the insurer's and patient's share of payment before the patient leaves the office. This collaboration has also expanded the availability and flow of information, as more providers and health care constituents capitalize on real-time electronic transactions via Availity's secure Web portal, they say.
But the initial migration of Texas physicians from THIN to Availity did not go smoothly. When physicians initially began switching to Availity in 2007, they saw rejection of large numbers of claims, particularly Medicare claims. Both Availity and Texas Medical Association officials say the root cause of that problem revolved around compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, which required national standards for electronic health care transactions.
THIN - owned by BCBS of Texas - was launched in the 1990s before HIPAA was enacted. When HIPAA standards for electronic transactions were implemented, many of THIN's physician clients were using proprietary practice management software that did not have HIPAA-compliant claim formats. So THIN developed "crosswalks" that could convert those formats into a HIPAA-compliant format without having the claim rejected. Availity, which started in Florida as a joint venture of Humana Inc. and BCBSF, is a much newer company and has required its customers to file HIPAA-compliant claims from the outset.
Availity worked closely with TMA to resolve those issues. Earlier this year, Mary Anne Orenchuk, Availity vice president of professional services, told Texas Medicine that the company had been working with submitters, payers, and software vendors to bring everyone into HIPAA compliance. She also said Availity had relaxed some edits that were causing claims rejections.
Ken Ortolon can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by e-mail at Ken Ortolon .