Group Seeks To Create Rules for Universal Data Exchange Software for Patient Insurance Information
A group of 50 major health insurers, medical associations, hospitals and technology companies have partnered to develop the first set of information-exchange rules for obtaining patients' health insurance information, the Wall Street Journal reports. Currently, the medical industry has "no single, easy way of checking whether a patient has a health plan and what it covers," according to the Journal. Physician practices with 10 doctors spend as much as $39,000 annually to verify coverage eligibility, while larger hospitals spend more than $1 million, according to a survey conducted for the Medical Group Management Association.
To address the issue, the Council for Affordable Quality Healthcare -- which includes Aetna, Humana, WellPoint, some Blue Cross and Blue Shield plans, Montefiore Medical Center in New York and CMS -- is working to create a set of rules governing the process of transferring patients' insurance information. The standards are intended to allow providers' patient data systems to "talk in the same language and work under the same operating rules," Robin Thomashauer, CAQH's executive director, said. Once the rules are established -- possibly as early as this fall -- technology companies will be able to develop software that health care providers could use to obtain coverage information for any patient from any participating health plan.
The software could be available by early next year, according to the group. Technology companies have "already said, 'If we can come up with the rules, the marketplace will build this,'" Carl Volpe, vice president of strategic initiatives at WellPoint, said (Fuhrmans, Wall Street Journal, 6/3).