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Humana and BCBSF Spur Effort to Provide More Integrated Real-Time Claims Adjudication Channels for Physician Offices

Humana, Availity, Blue Cross and Blue Shield of Florida and athenahealth Join Efforts


Monday, October 23, 2006 10:10 am EDT



Public Company Information:


LOUISVILLE, Ky.--(BUSINESS WIRE)--Humana Inc. (NYSE: HUM) today announced that the company, along with Availity LLC, its primary electronic data interchange and real-time gateway, will be working with other payers, claims clearinghouses and practice management groups to expand integrated real-time claim adjudication channels. The joint effort is part of an on-going initiative to simplify administrative tasks and help physicians obtain payment for services from patients more quickly.

This phase of the expansion will include physician practices that use athenahealth, with its revenue cycle management solution, and Blue Cross and Blue Shield of Florida, Humanas partner in Availity. The move is another example of the commitment Humana, Blue Cross and Blue Shield of Florida and Availity have to an integrated, simplified experience for doctors offices. The expansion was announced Sunday at the Medical Group Management Associations (MGMA) national convention in Las Vegas.

Humana launched an integrated real-time claims adjudication (RTCA) initiative earlier this year with the goal of making it easier for provider offices to get real-time information, simplifying the collection process, and allowing physicians to more accurately collect patient-owed portions of claims at the time of the office visit. It works especially well for doctors seeing patients with coinsurance-based plans, specifically high-deductible health plans. RTCA enables physicians to submit a claim at the time of service, receive a fully adjudicated claim response from the payer and collect the appropriate payment before the patient leaves the office.

We're pleased to collaborate with athenahealth and Blue Cross and Blue Shield of Florida on this real-time claims adjudication initiative, said Bruce Perkins, Humana's senior vice president of national contracting. Humana's new relationship with athenahealth and expanded role with Blue Cross and Blue Shield of Florida helps build a multi-payer solution with the power to reduce redundancy and complexity in the health care system. This program also reinforces Humana and Blue Cross and Blue Shield of Floridas dedication to being industry leaders in health care technology collaboration.

In our commitment to making it easier for providers to do business with health plans, Blue Cross and Blue Shield of Florida has been providing real-time claims adjudication as a value-added service to physicians, said Elana Schrader, M.D., vice president provider services for Blue Cross and Blue Shield of Florida. We are committed to a multi-payer solution and are pleased to see the participation of additional payers in order to expand the prevalence of this capability in the market.

The expansion increases the number of health care vendors who are already participating in this RTCA initiative, including ZirMed, which is the connection for most of Humanas current production sites.

athenahealths goal is to empower our provider clients with information that helps them collect what they are owed more quickly and efficiently. This has become increasingly important with growing patient responsibility due to the consumer directed healthcare movement, said Kim LaFontana, vice president of strategic alliances at athenahealth. We are thrilled to partner with a leader like Humana for this real-time adjudication pilot, as this is one of several areas we are aggressively pursuing to get providers relevant information at the time of service, which dramatically improves their bottom line.

As high-deductible health plans continue to increase in number over the next few years, doctors will grow increasingly frustrated if they have to perform RTCA differently for each payer. Humana believes that partnering with other payers through this multi-payer model is the most efficient and physician-friendly solution in the market today.

About Humana

Humana Inc., headquartered in Louisville, Kentucky, is one of the nations largest publicly traded health benefits companies, with more than 11 million medical members. Humana offers a diversified portfolio of health insurance products and related services through traditional and consumer-choice plans to employer groups, government-sponsored plans, and individuals.

Over its 45-year history, Humana has consistently seized opportunities to meet changing customer needs. Today, the company is a leader in consumer engagement, providing guidance that leads to lower costs and a better health plan experience throughout its diversified customer portfolio.

More information regarding Humana is available to investors via the Investor Relations page of the companys web site at http://www.humana.com, including copies of:

  • Annual report to stockholders;
  • Securities and Exchange Commission filings;
  • Most recent investor conference presentation;
  • Quarterly earnings news releases;
  • Replays of most recent earnings release conference call;
  • Calendar of events (includes upcoming earnings conference call dates, times, and access number, as well as planned interaction with research analysts and institutional investors);
  • Corporate Governance Information.

About Blue Cross and Blue Shield of Florida

Blue Cross and Blue Shield of Florida is a leader in Florida's health industry and is committed to working for an excellent, efficient health system. BCBSF is a leader in providing innovative capabilities including CareCalc, the industrys first capability that helps providers and members understand the financial responsibility for health care services prior to or at the time of service. BCBSF and its subsidiaries serve more than 8.6 million people. Since 1944, the company has been dedicated to meeting the diverse needs of all those it serves by offering an array of choices. BCBSF is a not-for-profit, policyholder-owned, tax-paying mutual company. Headquartered in Jacksonville, Fla., BCBSF is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information concerning BCBSF, please see its Web site at www.bcbsfl.com.

About athenahealth, Inc.

athenahealth provides the only physician revenue and clinical cycle management offering that integrates web-based practice management and EMR software, continually updated payer knowledge, and back office processing specialists into a single service. The results are faster payment at lower cost, increased patient care, higher revenue retention and less hassle for the more than 8,000 providers using athenahealth nationwide. The company collects close to $2 billion on behalf of its clients annually. athenahealth is dedicated to helping providers make optimum use of their time, ultimately improving the quality of service delivered and the financial reward for it. For more information about athenahealth, visit our Web site at www.athenahealth.com or call 1-888-652-8200.


Humana Corporate Communications
Dick Brown, 502-580-3683