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PENNSYLVANIA BLUE SHIELD DELCARES MOVE TO PAPERLESS HEALTH CARE CLAIMS IS EVIDENT

 CAMP HILL, Pa., Dec. 23 /PRNewswire/ -- During a 10-year span, the receipt of paperless electronic health care claims by Pennsylvania Blue Shield has increased from 818,000 in 1983 to a projected 37.9 million by the end of 1992.
 "As more physicians and other health care professionals begin to use electronic technology to simplify the task of processing claims, we are getting closer to a paper-free claims environment,"said Margaret M. Lanshe, Vice President of Private Business Claims and Systems at Pennsylvania Blue Shield.
 Lanshe believes that by moving to an electronic claims environment -- beginning with the physician's office -- the entire health care system will benefit through overall operational savings and a more simplified claims filing system.
 Because administrative costs are an important health care policy issue in the U.S., the federal and state government, the health insurance industry and the health care community are looking for ways to improve administrative efficiency.
 "Right now combined operating costs for Pennsylvania Blue Shield and the state's Blue Cross Plans are 6.5 percent -- the lowest in the nation. As the largest Blue Shield plan in the U.S., we process a total of nearly 38 million Private Business claims a year for medical- surgical, dental, vision and medigap services. And as the largest Medicare carrier in the nation, we process over 70 million Medicare Part B claims a year," said Lanshe.
 Of the 18 million medical-surgical claims Blue Shield receives during the year, 34 percent of those claims are transmitted electronically. And more than 50 percent of the Medicare Part B claims the insurer receives are transmitted electronically.
 "As the demand for health care services continues to rise, so will the number of claims we process. One way we can realistically hold the line on our current operating expenses is to receive more claims electronically," explained Lanshe.
 Unlike Pennsylvania Blue Shield and the state's Blue Cross plans, many other health care insurers are facing upward to 25 percent or more in operating costs. The difference in administrative costs is a major issue in the national health care system debate.
 Spurred by government efforts to reduce administrative health care costs, Congress approved in October President Bush's request to permit health care insurers to pay Medicare Part B electronic claims sooner than paper claims. Insurers will implement the new payment guidelines beginning January, 1993. This is intended to provide an incentive to encourage more physicians to file claims electronically.
 Currently over 50 percent of Medicare Part B claims are submitted electronically to health care insurers throughout the nation. HCFA's goal is to increase that number to 68 percent in 1993 and to 75 percent in 1994.
 Although the concept of using electronic technology to process claims may be a new idea for some insurers, Pennsylvania Blue Shield has been leading the way since 1983 when the insurer first accepted health care claims on magnetic tapes. In 1985 doctors and other health care professionals began using telephone lines to submit claims.
 Today over 500,000 medical-surgical claims and nearly 3 million Medicare Part B claims are transmitted electronically each month to Blue Shield.
 "Filing claims electronically is quick, easy and inexpensive. All you need to send medical-surgical and Medicare Part B claims to Blue Shield is a personal computer, software and a modem," said Lanshe. The insurer will even provide free software, technical support and advice in choosing a computer system for offices that do not already have one.
 In addition to receiving claims payment faster, medical practitioners can use existing systems, now, to better project their cash flow while office assistants can streamline bill collections and avoid filing duplicate claims. And Lanshe says that claims can be transmitted electronically to Blue Shield 24 hours a day, seven days a week.
 Pennsylvania Blue Shield also provides practice management reports for every medical office that transmits claims electronically to the insurer. These reports acknowledge receipt of any claim the insurer receives and also indicates whether a claim has been accepted into the insurer's computer system.
 Pennsylvania Blue Shield serves nearly 6 million subscribers in its medical-surgical programs and administers Medicare Part B claims for 3.3 million beneficiaries in Pennsylvania, Delaware, New Jersey and the District of Columbia metropolitan area.
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 EFFORTS UNDERWAY TO ENCOURAGE USE OF ELECTRONIC TECHNOLOGY
 TO FILE CLAIMS AND EXCHANGE DATA
 -- Pennsylvania Blue Shield hosts regional conferences throughout the state where software vendors, health care providers and office managers learn about computer hardware, software and the benefits of using electronic technology to manage their medical practice. The insurer provides free software and technical support for medical practices.
 -- Blue Cross and Blue Shield Plans throughout the nation are working with other insurance companies, hospitals, the medical community and a number of other businesses to develop standards for electronic communication to make claims filing easier for everyone. Currently there are over 400 different electronic formats used to transmit information related to the delivery and financing of health care, including enrollment, eligibility, benefit coverage, and claim and payment information. Insurance companies and the health care community frequently invest in multiple computer systems or programs to support these 400 different formats.
 The new standards will enable physicians and hospitals to have one "universal language" to use when filing claims electronically or exchanging health care data -- regardless of what software package or computer hardware they use.
 -- Electronic remittance advice (ERA) will automatically post claim payments to a provider's accounts receivable system, and electronic funds transfer (EFT) will automatically deposit claim payments directly into a provider's bank account. Pennsylvania Blue Shield is already using ERA.
 -- With the increase in managed care programs, electronic data exchange will enable providers to have immediate access to a patient's medical records and the capability to transfer patient data and clinical information to other health care providers and hospitals.
 /delval/
 -0- 12/23/92
 /CONTACT: Jean B. Edwards of the Pennsylvania Blue Shield, 717-975-7376/


CO: Pennsylvania Blue Shield ST: Pennsylvania IN: INS SU:

MJ -- PH019 -- 9649 12/23/92 15:18 EST
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Date:Dec 23, 1992
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