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Automated network spans the nation; Tri-Care computerizing to improve the efficiency of processing health-care claims.

Automated network spans the nation

On the sixth floor of a downtown Sudbury office building sits a computer which will eventually process a majority of the nation's group health insurance claims.

The $12.9-million electronic claims-processing system is being phased in over the course of a year. It will enable health-care professionals to access data on a patient's benefit package via computer.

The system, called HealthNet, is an integrap part of the operations of the Tri-Care Group of Companies, this year's winner of the Company of the Year Award (51+ employees) which is sponsored by the Royal Bank of Canada.

Tri-Care provides administrative services to more than 64 per cent of the major health insurance companies in Canada. It provides the same service to 140 corporate insurers which include the Toronto Dominion Bank, Consumers Distributing, Falconbridge Ltd. and Purolator Courier.

The accounts represent $33.5 million in total annual premiums.

The Tri-Care group consists of four separate companies. Robert Morel is president of the parent company, Tri-Care Services Ltd., and is chief executive officer of member companies Directcard Identification Systems Ltd. (Rx Plus), Multi-Care Systems Ltd. and HealthNet Systems Inc.

Each of the three subsidiaries has a role to play in the processing of claims. Directcard administers pay-direct drug plans; Multi-Care links the system with computers in pharmacies, hospitals, dental offices and optical dispensaries; and HealthNet is the coast-to-coast computerized communications network.

Incorporated in 1982, Rx Plus is Canada's largest third-party claims processor. Morel anticipates it will make payments totalling more than $75 million this year on behalf of insurers.

According to a report prepared by Rx Plus, as of April there were approximately 200,000 Rx Plus card holders, representing an estimated 530,000 Canadian residents.

Of the approximate 6,900 pharmacies in Canada, Rx Plus has contracts with 6,320, incuding 2,321 in Ontario alone. The company's major competitors are Blue Cross and Greenshield.

The automated HealthNet system is approaching full implementation.

The installation of host computers in regional offices in such places as Toronto and Windsor will complete the system. They will process data from computers in pharmacies and hospitals and relay it to Tri-Care's main computer in Sudbury.

Vital to the entirey system is a credit-card-sized "smart" card with a built-in computer chip containing up to 16 pages of in-information concerning a patient's health benefits and prescriptions. The research and development phase of the system was completed over a three-year period.

Morel reports that on Aug. 24 he oversaw the successful hook-up of the first two pharmacies in the network. Both are located in Nova Scotia.

According to Morel, the automated system will speed up the processing of claims from 34 days to 20 seconds. He estimates that the system will reduce a subscribing company's administrative costs by as much as 40 to 50 per cent.

In addition, Tri-Care officials hope to export the HealthNet technology around the world.

The project, when complete, will result in the addition of 118 employees over the next three years, says Morel. The Tri-Care group of companies currently employs 110 people.

According to Morel, Tri-Care's entire staff play a role in the development and continued success of the company. He says that through regular middle-and senior-management meetings held to discuss the company's performance and strategies, "everybody knows where we want to go."

"You can't think for today - you must always stay on top of strategic planning and never forget to provide efficient and quality service," says Morel.
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Title Annotation:Northern Ontario Business Awards Thunder Bay 1990; Company of the Year 51+ employees
Publication:Northern Ontario Business
Article Type:company profile
Date:Dec 1, 1990
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