UnitedHealthcare Streamlines Claims Adjudication For Physicians and Consumers

MINNEAPOLIS (April 11, 2007) --UnitedHealthcare, a UnitedHealth Group (NYSE: UNH) company, announced that physicians nationwide who work with UnitedHealthcare may now submit their claims for adjudication in real time.

Doctors offices may now submit their claims online through UnitedHealthcare physician Web site, UnitedHealthcareOnline.com, instead of submitting claims in bulk or after patients visits. Real-time adjudication helps reduce administrative hassle, freeing doctors and their staffs to care for patients rather than handle excess paperwork.

Receiving an approved, fully adjudicated claim in less than 10 seconds also means consumers will know exactly how much their doctor visits cost before leaving the office. Previously, the typical claims-adjudication process could take days or weeks. The new process provides access to the actual cost of care, at the point of care.

"This is a significant advance in our continuing efforts to improve the health care system. Real-time adjudication lowers costs for consumers and physicians while reducing one of the most significant hassles in health care: the billing, collection and settlement of a health care transaction," said David Wichmann, UnitedHealth Group executive vice president and president, Individual and Employer Markets Group. "In addition, by providing more information in a timelier manner, we can help consumers better understand the financial aspects of their health care decisions."

After entering the patient's eligibility information and proper codes for services received at the doctor's office, UnitedHealthcare determines and confirms in less than 10 seconds the total allowed cost of the procedure under contract, the amount to be reimbursed through health insurance and any amount the patient may owe.

UnitedHealthcare launched the capability nationally Jan. 1, 2007, after a pilot program with a small group of physicians in Rhode Island last summer.

While many doctors may access real-time claims adjudication through UnitedHealthcareOnline.com, the company will soon make the capability available to physicians through other channels including third-party claims clearinghouses. Pilot projects will begin in the second quarter with a couple of clearinghouse partners, including Payerpath, a Misys company. This is the first real-time claim-adjudication pilot for Payerpath and will include a select group of health-care professionals across the country.

"UnitedHealth Group has long promoted connectivity solutions for all health care providers," Wichmann said.  "In order to truly streamline the system for physicians and consumers, we need to advance technologies that operate on a single platform and can be used by anyone within the health care system."