HIP Health Plan Streamlines Prior Approval Communication with Physicians

New York, NY October 19, 2005 - A new system started by HIP Health Plan of New York to make things easier for physicians is gaining momentum while saving time and money.

PEP (Provider Electronic Platform) created by HIP to streamline physician interaction and referrals is averaging 2,500 online referrals and prior approval transactions daily for a total of 155,000 since the system completed its rollout in May 2005. At the same time, HIP has so far saved more than $800,000 with a potential annual savings of $2.4 million in administrative and medical costs.

The PEP system processes specialist referrals, prior authorizations and emergency room admissions. The system allows participating physicians to process online via a secure Web site and it provides all the information physicians need to submit claims electronically, including current and prior eligibility, use of benefits and the status of prior claims. Previously, physicians' offices performed those functions on paper or through telephone calls to HIP.

To be certain that PEP would be useful to health care practitioners, HIP conducted focus groups with physicians, hospital staff and providers of durable medical equipment, dialysis, and home health care practitioners to gather suggestions on the system's design and functions. Based on that input, HIP simplified referrals and prior approvals for radiology services and added more details in online responses and inquiries.

Before actually implementing the PEP system, HIP provided training to 5,000 physicians and more than 100 hospital staffs at approximately 4,000 locations.