MyInsuranceManager Web Precert
BlueCross BlueShield of South Carolina
Contemporary managed care requires frequent communication between the provider and health plan. This online tool allows providers to meet the reporting needs of the health plan with less effort, when and where it is most convenient for the provider.
Program Elements
- In 2004, BlueCross BlueShield of South Carolina (BCBSSC) took steps to respond to provider requests for an online precertification tool. For years, precertification requests were handled through one of 3 utilization management call centers. In this model, providers initiated a precertification by fax or telephone followed by submission of clinical information by fax.
- BCBSSC recognized that this process could be greatly simplified by giving providers the opportunity to submit and service precertifications online.
- MyInsuranceManager, BCBSSC's secure web portal, was the logical vehicle for this functionality. To enhance the process, BCBSSC designed a prototype web precertification tool called Web Precert.
- BCBSSC conducted usability testing with providers that regularly used existing MyInsuranceManager applications to ensure that Web Precert was user-friendly and met the needs of providers and provider office staff.
Program Results
- Web Precert was met with rapid acceptance. Over 46% of all precertification requests and inquiries are now handled online, greatly reducing the use of long-distance telephone calls to Utilization Management centers.
- 87% of online precertification requests result in automatic, real-time resolution.
- BCBSSC has achieved costs savings thanks to Web Precert and is forecasted to achieve 100% ROI a full nine months sooner than expected.
- Internal direct medical management PMPM expenses have fallen 20% since adding Web Precert functionality. If current trends continue, cumulative costs savings related to Web Precert would total over $1.4 million by Q4 of 2007.
Contact
David Boucher, AVP Health Care Services, 803-264-3256, david.boucher@bcbssc.com
