Industry Collaboration to Simplify Office Administration

Blue Cross Blue Shield of Massachusetts

A 2003 survey conducted by Blue Cross Blue Shield of Massachusetts (BCBSMA) revealed that 54 percent of physicians reported seeing a larger number of patients than the previ­ous year, and 64 percent reported working longer hours. Administrative tasks required by government programs and health insurers, typically handled by a larger staff, were in some cases being handled by the physicians themselves. Though these tasks are critical to modern-day healthcare delivery, they limited physicians' availability to see patients.

Program Elements

• Average physician offices in Massachusetts deal with at least 15 managed care organizations, each with its own referral and claims processes . This greatly increases the time office staff and physicians are required to spend on time-consuming administrative tasks. Simplifying and standardizing some of these procedures would require tremendous collaboration and cooperation between insurers, physician groups and other stakeholders.
  
  
• In 2002, BCBSMA founded the Massachusetts Roundtable, along with the Massachusetts Medical Society, the Massachusetts Hospital Association, the Massachusetts Hospital Association of Health Plans and several key physi­cian groups.

Program Results

• BCBSMA suggested that this group form smaller Professional Administra­tive Simplification Workgroups to tackle inefficiencies. Each of the criteria were identified as areas where competing health plans could collaborate to develop smooth, efficient and cost-effective administrative procedures across insurers.
  
  
• Credentialing and re-credentialing physicians – developing a uniform application for Massachusetts providers.
  
  
• Office administration – providing online resources to physicians and patients for "e-visits" and online claims administration.
  
  
• Filing limits – working to set uniform deadlines for claims and appeals across health plans in Massachusetts.
  
  
• Prior authorizations – standardizing and streamlining information required by plans.
  
  
• Referrals – simplifying the process and in some cases eliminating the need for referrals altogether.

Contact

Vincent Plourde, VP, 617-246-7632, vincent.plourde@bcbsma.com