Online instead of on phone

Tennessee is benefiting from a fee-based Web system for checking insurance eligibility

Doctors and hospitals are using a Web-based service to check on patient eligibility in Tennessee's managed health care program, greatly reducing telephone inquiries.

Debra Luling, general manager of the state's portal, called Tennessee Anytime (www.tennesseeanytime.org), said the fee-based service debuted July 1 and usage has been greater than expected. In August, more than 40,000 requests were processed online, representing a 39 percent adoption rate. She said that state officials expect that there eventually will be an 80 percent to 90 percent adoption rate.

On average, TennCare processes more than 105,000 requests a month. TennCare (www.state.tn.us/tenncare) is the managed health care system for 1.4 million residents who are eligible for Medicaid or who are uninsured or uninsurable.

"It was a heavily burdensome process," said Luling, referring to the telephone inquiries, which are free. She said she didn't know how much of a reduction in calls the state has experienced.

But although medical providers -- more than 20,000 are part of the network -- can still make a telephone inquiry, she said about 10 to 15 of them a day are subscribing to the $75 service that gives unlimited use for a year. Subscribers can apply online and are given a user ID and password.

It's useful, she said, because sometimes a citizen may not have the eligibility card when seeking medical service. A quick Web check verifies the patient's eligibility, his or her insurance coverage and whether it includes hospitalization and prescription drugs, third-party liability and other information.

The sensitive data is delivered in real time and security is "paramount," said Luling. The application is HIPPA-compliant, she said, referring to the 1996 federal Health Insurance Portability and Accountability Act, which, among other things, was enacted to create national standards for health information and improve the security and privacy of shared medial information. States must comply with data standards by October 2002.

She said a third-party vendor audits the entire state portal quarterly, reviewing its rules and firewall policies and scanning the network for vulnerabilities. State officials review the reports and then have 60 days to correct any problems, she said.

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