Health insurers look at
IT investments, particularly
in billing and payments,
to respond and adapt to
upcoming changes
in the market.
e-BillingThe
Conundrum
By John McCormack
Glen Schuster, SVP and CTO at Centene Corp., a St. Louis-based multi-state gov- ernment services managed care company, is coping with some exceptionally difficult challenges.
“Insurers are facing some of the biggest challenges ever,”
says Ann Brisk, VP, banking solutions at OptumHealth Financial Services. “Topping the list is health care reform
and how it impacts a health plan’s ability to stay profitable.
To make it through these challenges, insurers need to take
another look at how they are embracing technology.”
SQUEEZING MORE OUT OF I T
Hartford, Conn.-based Aetna Health, for example, has
been making substantial investments to its IT systems
to comply with the benefit provisions of the Affordable
Care Act (ACA), according to Matthew Wiggin, a com-
pany spokesperson. For instance, policy administration
and billing systems had to be adjusted to reflect new
life-time benefit limits and other changes that emanated
from ACA. “Dozens of applications were impacted, and
we had to comply with hundreds of systems require-
ments,” Wiggin says. “So, we had a dedicated project
management team work with our IT department to
implement all the changes.”
Similarly, Centene’s Schuster is creating a billing
environment that can handle the expected increase in
patient demand that is emanating from reform. Equally
important is easing the interaction between insurers and
similarly hard-pressed physicians, Schuster says. Cen-
tene is working with Emdeon, a Nashville, Tenn.-based
provider of revenue and payment cycle management
software, to provide electronic billing transactions to
providers. If providers are able to submit claims faster
and more accurately because it is easier for them, Cen-
tene is able to process the bills quicker.
insurancenetworking.com
may 2011 insurance networking news 21
