CONSUMERS LIFE OFFERS REAL-TIME CLAIMS PROCESSING SYSTEM IN INDIANA

FORT WAYNE--Consumers Life of Indiana has developed and piloted its own Real-Time Claims Adjudication (RTCA) system to enable patients to instantly take care of financial obligations at the point and time of their medical care.

Introduced in October 2008, RTCA was piloted by four physician offices. Feedback from the physicians of varying specialties indicates that the system is easy to use and patients too find it easier to conduct business at the point of service.

“The results are encouraging,” said Don Pirc, Consumers Life director of Network Management. “As for expediency, the claims submitted are fully adjudicated and returned to the physician and member in seconds,” Pirc said.

The web-based RTCA system was developed in-house by Consumers Life parent company Medical Mutual and mirrors the layout of a claim form. The system provides users with the status of a completed claim within seconds of submission. The resulting documentation is an Explanation of Benefits (EOB), which is printed and provided to the member for his/her records.

The RTCA system was integrated into Consumers Life’s Provider e-Portal earlier this month, allowing all network physicians to utilize the system. In addition, an internal RTCA steering committee is monitoring progress made on claims cost estimators, which may be coupled with the RTCA system to offer additional value to Consumers Life providers and members alike. RTCA and the upcoming claims cost estimator will be accessible through Consumer Life’s new Provider e-Portal, or the members’ My Health Plan website http://www.consumerslife.com/

“This is an important step for our customers and provider clients because, as the transformation of the healthcare marketplace continues, Consumers Life recognizes that consumerism and transparency will be significant components,” said Pirc.

Consumers Life Insurance Company is a subsidiary of Medical Mutual, the oldest and largest health insurance company based in Ohio. The company is licensed to sell health insurance products in 28 states and the District of Columbia. Consumers Life serves its customers through high-quality, affordable group and personal health insurance plans, and third-party administrative services to self-insured businesses. For more information, visit the company’s Web site at ConsumersLife.com.