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Researchers from the medical school's Department of Health Care Policy selected BlueCross' "Web Precert" tool as one of seven national BlueWorks® winners in honor of "BlueWorks for Providers Week," Sept. 10-14.
BlueWorks is a partnership between the Blue Cross and Blue Shield Association and Harvard's Department of Health Care Policy that recognizes innovative Blue Cross and Blue Shield companies working with doctors and hospitals to increase the efficiency and consistency of care delivery nationwide. Harvard researchers judged Blue Cross and Blue Shield local programs on innovation, efficacy, robust design and the potential for program replication. Since 2004, Harvard Medical School's Department of Health Care Policy has named 35 Blue Cross and Blue Shield programs as BlueWorks winners.
A pre-certification from the insurer to the provider is required for some medical services. With Web Precert, physicians go to the secure My Insurance Manager(SM) section of www.SouthCarolinaBlues.com or www.BlueChoiceSC.com and enter the member's identifying information to determine if pre-certification is required. If pre-certification is needed, the physician or staff member can enter clinical information online and receive a response for the majority of requests within seconds. About 13 percent of requests are held until additional clinical information is submitted.
Prior to implementation of Web Precert in 2005, doctors' offices submitted these requests by telephone or facsimile.
"I would say it saves me at least 15 to 20 minutes per pre-certification, and that is very important for me because I pre-cert for seven doctors," said Vicki Peebles, director of marketing and pre-certification for Blue Ridge Orthopaedics Associates in Seneca, S.C. "I can get backed up very quickly if I have to request a pre-certification by phone and I'm on hold for 30 minutes. I can complete a request online with BlueCross in less than five."
David Boucher, assistant vice president of Health Care Services for BlueCross, said Web Precert was developed because physicians requested the ability to obtain pre-authorizations online.
"BlueCross BlueShield of South Carolina is committed to providing our physicians, facilities and other health care providers with the information and tools they need to interact with us in the most efficient manner possible," Boucher said. "We believe the ability to access key authorization information quickly and easily promotes quality service and enables better health care for our members."
Dr. Barbara J. McNeil, head of Harvard's Department of Health Care Policy, said Web Precert allows physicians to communicate with BlueCross more efficiently.
"Contemporary managed care requires frequent communication between the provider and health plan," McNeil said. "This online tool allows providers to meet the reporting needs of the health plan with less effort, when and where it is most convenient for the provider."
Headquartered in Columbia, S.C., BlueCross BlueShield of South Carolina and wholly owned subsidiary BlueChoice HealthPlan of South Carolina Inc. are independent licensees of the Blue Cross and Blue Shield Association. BlueCross BlueShield of South Carolina and its family of companies include more than 20 subsidiaries involved in health insurance services, U.S. DOD health plan and Medicare contracts, and other insurance and employee benefits services.
BlueWorks is a registered mark of the Blue Cross and Blue Shield Association. My Insurance Manager is a service mark of BlueCross BlueShield of South Carolina.
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