Despite the headway, CEO Jim Denny, Jr., believes the health care industry squandered the opportunity that the HIPAA rules gave to significantly increase the volume of electronic financial and administrative transactions.
Navicure in 2007 processed 48 million transactions, most of them electronic claims and remittance advice. By December 2008, the Duluth, Ga.-based vendor was on track to process 75 million transactions for the year, again, mostly claims and remittance.
The clearinghouse has always offered eligibility verification since being formed eight years ago. However, it just doesn't get a lot of business for those transactions.
"Eligibility is getting a lot of attention these days and we're promoting it," he notes. "But for all the talk, it's not getting the traction."
That's because content in the eligibility responses from most payers still is not useful to providers, Denny says. "Information regarding what services are covered and the status of the deductible are inconsistent across payers."
One big challenge in growing electronic transactions is getting practice management software vendors to enable physician practices to access clearinghouses that the vendors don't own or have a relationship with, Denny says. "HIPAA was implemented to enable the free flow of transactions between systems," he adds. "Every practice management vendor can support the transactions, but some choose not to because they gain financially when they promote certain clearinghouses."
One bright spot with regard to HIPAA has been growth in the availability of the 835 electronic remittance advice transaction set of payment information, he notes. "We are able to deliver a companion ERA for 75% of our claims. That enables clients to post payment information electronically."
More Squeezing
Navicure is focusing on enhancing its claims management software as providers become squeezed further with lower reimbursements. Providers also must contend with more high-deductible health plans with health savings accounts.
Denny looks at changing market conditions for his 2,500 group practice clients representing 14,000 physicians and does not like what he sees coming. "High-deductible health plans will have a huge impact on the industry in the first quarter of 2009."
As the economy has declined over the past year, more employers have opted to offer less expensive high-deductible health plans, he explains. But with many HSAs not being fully funded by employers or account holders-certainly at the start of the year - a growing number of patients won't be prepared to pay for treatment, he predicts.
That's why Navicure expects in the second quarter to release version 5.0 of its claims software. "It is a fundamental change in the way we serve information to our clients," Denny says.
The new software will automatically push information to clients for which they previously had to search. For instance, a user when logging in will receive alerts on issues - such as a list of rejected claims not worked on for more than two days - that need attention.
New data repository and reporting capabilities will enable clients to benchmark performance measures against peer organizations. A user will be able to find out how long it takes the practice to file claims from the date of service or to correct denied claims, compared to similar practices.
Preparing for the HIPAA 5010 transaction sets and the ICD-10 code sets also is high on Navicure's agenda for 2009.
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