For years, Aetna Inc., like most major payers, had used its own physician Web portal to communicate with contracted providers. When executives determined they wanted to revamp the self-developed portal to offer a much broader range of secure transactions, they carefully weighed whether the insurer could handle the massive project on its own.
We evaluated building the portal ourselves again. But when we looked at what technology was on the market, it made a lot more sense for us to outsource it with a system that already had what we wanted, says Paul Marchetti, head of Aetnas national networks and contracting services department. And just because Aetna could have developed its own proprietary brand doesnt mean that providers would like it.
Last fall, the Hartford, Conn.-based insurer began implementing the NaviNet portal technology from NaviMedix Inc., Cambridge, Mass. More than 14 other managed care organizations use the portal technology, including some of Aetnas biggest direct competitors: Cigna, United Healthcare and several Blues plans.
We wanted to differentiate ourselves, but the truest value for the provider is standardization, Marchetti contends. This technology enables the balance of this standardization with the ability of each payer to maintain its own brand within the portal.
The more payers that are involved in this, the more benefits the providers can get.
Moving to a common physician portal makes sense for many managed care organizations because of all the administrative woes their proprietary systems have caused, says Diane Walizer, a regional manager at Beacon Partners, a Weymouth, Mass.-based consulting firm.
When payers had proprietary technology for these types of initiatives, it was frustrating on the provider side, she says. The front desk and billing departments had to manage individual information for several different payer organizations. It was very inefficient.
More payers may face pressure to join a shared portal as more physicians begin using them, Walizer contends. More than 454,000 physicians use NaviNet to initiate various transactions with some payers, according to the vendor.
Aetna and Cigna have such big provider bases that now are using this technology, she says. So every physician will begin looking at what technology their other payers are offering and start putting the pressure on them to switch.
Because the NaviNet portal, https://navinet.navimedix.com, already was so well-established, Aetna didnt have to spend much time customizing it or training its physicians to use it, Marchetti says. More than 170,000 of its contracted physicians already were using the portal to communicate with their other payers before Aetna adopted it.
Compared to its homegrown portal, Aetnas new portal offers improved functions, customized transactions, easier provider navigation and more flexibility with content management, Marchetti says.
Payers, including Aetna, use the NaviNet portal through the application service provider computing model. In this way, they can customize their section of the portal while leaving maintenance to the vendor. Health plans pay for the service either by a monthly or per transaction service charge.
The portal enables payers to transmit information to their contracted physicians via a secure Web connection. Payers use several different methods to set up repetitive data exchange transactions from their core systems to the portal. Then they can use other technology within the portal to add customized functions. Payers also can test new functions and receive feedback at regularly NaviNet user groups.
The vendor helped Aetna develop an interface between its self-developed managed care information system and the portal to transmit its data. But because Aetna already was using some of the same HIPAA transaction standards with its previous portal, it was a mostly seamless process, Marchetti says.
The information transfer took some time, but the vendor worked closely with us to get it done, he says. But the structure really was already there.
Physicians can register to use the free portal by entering their tax identification number, their health plan and other contact information. During the registration process, physicians also can request the vendor solicit other managed care organizations to use the portal.
Once registered, providers enter a user name and password to log on. Then they can establish role-based access for various employees in their organizations, such as by restricting front office staff to view only insurance eligibility information and limiting billing staff to view only financial data.
To initiate a transaction, providers choose one from a menu on their payers main screen within the portal. If providers work with multiple health plans that participate in NaviNet, they can click a tab within the portal to access transactions with another payer without signing on again.
Providers then enter the patients name, member identification number, date of birth, and date of service to initiate a transaction.
Aetna offers nearly 40 real-time transactions via the portal, including pre-certification, treatment authorizations, insurance eligibility verification, claims status checks, referrals, diagnosis and procedure code lookups, credentialing, remittance advice and funds transfers.
Physicians have the option of submitting claims via the portal or through a growing list of clearinghouses (see cover story, January 2008 issue, page 29).
The NaviNet portal offers us more flexibility over our content, updates and provider education than we had with our old system, Marchetti says.
Aetna continued to accept transactions via its old portal when phasing in the NaviNet portal. But it expected to shut down the old portal this month.
After the transition is complete, Aetna plans to use the new portal as a foundation for other types of communication with doctors, Marchetti says. This could include clinical data exchange.
For more information, visit the managed care portal at healthdatamanagement.com.
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