Finding a cover for a 'black hole'.

BlueCross BlueShield of South Carolina's Superbill project is taking technology to new heights by allowing users to store their most commonly used procedures, prices and diagnoses in their profile and then file claims online by clicking checkboxes instead of keying numeric data.

About the Project:

In 2004, the Blues plan received more than 130,000 phone calls from providers for claims not on file, said David Boucher, assistant vice president of health-care services, during an Oct. 3 webinar about the project. "We knew there was leakage along the electronic highway, or what's often referred to in the industry as the 'black hole.'"

To complete the project, BlueCross BlueShield of South Carolina spent about 9,600 IT hours and close to $1 million, Boucher said.

Business Purpose:

Superbill is a free, point-of-service tool allowing providers to immediately learn the exact amount to collect from the patient and the precise amount they'll be reimbursed by BlueCross. The target population can use Superbill to file claims online for three lines of business: BlueCross BlueShield of South Carolina (Preferred Blue and BlueCard), State Health Plan and BlueChoiceHealthPlan.

Strategy:

"We wanted a means of improving provider satisfaction and also increase our electronic media claims. We wanted to implement a faster method for physician offices to submit claims directly to BlueCross and then deliver them a realtime, fully adjudicated claims response," he added. Users can complete and submit a Superbill claim in 20 seconds.

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Technological Innovation:

The plan made significant technology strides over the past several years, including its most recent implementation in 2006.

The Java-based Web application can be accessed from any computer with an Internet connection, and providers can access Superbill via a My Insurance Manager, BlueCross BlueShield of South Carolina's free, secure online portal for health-care providers.

Results:

Since its implementation, the Superbill feature has yielded tangible cost savings by moving more of its customers' claim submissions to the Web. Since August 2006, more than 120,000 online Superbill claims have been processed, saving between $100,000 to $150,000 in indexing, imaging and data entry costs, Boucher said.

He added that the total number of professional claims filed online has increased more than 8% in the year since the company implemented Superbill, and that provider inquiries for claims not on file received by the plan has dropped to 65,000 thus far in 2007.