What’s a Provider Portal?


Sponsored by The Reimbursement Group

If you’re responsible for the management of a Physician Practice, or an Ambulatory Surgery Center, or a Clinic, your job just got that much harder!

Starting next week Anthem Blue Cross Blue Shield, (the single largest health insurance plan in the United States with over 35 million members), is changing the way they interact with their physician providers. Again. Here’s how.

Anthem’s new recording advises, “After September 5, 2014, Anthem will no longer provide phone status updates. All updates must be done through Availity.com the Provider Portal. The letters will continue to be sent to the office.” Anthem is not alone in this change. They are joined by other Blue Cross Blue Shield plans including Highmark and Excellus. Whether directing clinicians to a clearinghouse like www.availty.com or to their own homegrown access point, this represents yet another change in plan processes driven by the implementation of the Patient Protection and Affordable Care Act (a.k.a. Obamacare).

At first blush this new process would seem to improve efficiencies, likely reduce processing times for prior authorizations and appeals, and perhaps even result in shared reduction of costs. But we must also consider that many offices simply do not provide internet access to their business or billing staff. There’s a cost, both direct and perceived lost productivity, inherent in this access. A large share of practitioners source their billing to an outside company, which further reduces the perceived benefits of internet access for their in-house staff. Historically, there has been no need for front-office staff to access the internet. Clearly, that’s about to change.

The Reimbursement Group (TRG) supports business functions related to new technologies in healthcare. We develop and run reimbursement hotlines. Our case managers work to obtain authorization for benefits on prescribed services. We’re very, very good at what we do. Based on our experience, we project that something in the neighborhood of 50% of private healthcare offices do not have internet access. TRG is daily bridging the gap between changes at the Plan/Payor level with capabilities at the provider or manufacturer level. Under Obamacare, that gap is ever widening. It is further exacerbated by the long time lines present in this industry in recognizing, understanding, and then adapting to process changes. For example, there was a 1 to 2 year delay in spine surgeon awareness of coverage policy changes restricting initial surgeries to single-level instrumentation. Though the policies themselves varied, there was a significant delay between the implementation of the policies to when surgeons changed their documentation and prescribing.

TRG expects a ripple effect with the Anthem change. There will be meaningful delays in scheduling non-emergent surgeries and procedures. Physicians will experience significant problems with claim denials. Patients will be left holding the proverbial bag, having to suffer for both of these shortcomings themselves.

So what is a Provider Portal? It’s the plan’s physician access point on their website. It requires login identification and passwords. Staff will need their boss’ Tax ID number and national provider identifier (NPI) for access. Physicians, the next step is yours!

This post was first seen on LinkedIn

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