A healthcare organization that wanted Web access to its Amisys Payor Solutions for its providers got to provide the access itself, using Speedware’s professional services group and its own IT staff. Now the solution is ready for sale to the rest of the Amisys community.

Health Plan of San Mateo (HPSM) is a Medicaid managed care program that operates much like a HMO for Medi-Cal recipients in San Mateo County, Calif. HPSM handles membership eligibility, pays claims, and has offered provider networks to over 40,000 members for 13 years. In the past year, the health plan connected its providers to the Amisys Payor database through the Web.

HPSM was one of the many sites that looked forward to more Web capabilities in the Amisys software, but it wasn’t satisfied with the NetManage module Amisys customers can deploy. MIS Manager Eben Yong said he wanted to reduce turnaround time on claims processing and go beyond NetManage. Using Autobahn and the Speedware Professional Services consultants gave him Web Claims.

Yong said it was important to keep costs of operation low for the health plan, because it serves those who have no other insurance. As a Medi-Cal HMO, HPSM insures the indigent, the elderly and those who have little means to pay for health care. The claims process submission can now be accomplished through PCs and Web browsers in doctors’ offices, which has cut the turnaround time to half of the industry average.

HPSM provides free PCs and configures them for the doctors’ staffs as part of the Web Claims service. Yong said the most challenging part of the project wasn’t in development, but in deploying the PC resource.

“Even though we’re pretty much in Silicon Valley, there’s a good number of doctors’ offices and pharmacies that have never touched a Windows PC before,” Yong said. “If it’s that way here, I suspect it will be that way elsewhere — which is one of the hurdles to be faced in the Internet connectivity effort.”

NetManage is also a Speedware application created by HBOC for Amisys customers. But the application only looks up authorizations through the Medical Management Subsystem on the HP 3000, as well as membership eligibility lookup and claims status inquiry. “The missing piece out of all these items was the claims submission,” Yong said. “We extended NetManage to allow for the submission of claims, fully secured, over the Internet.”

“There’s a good measure of connectivity there, but it’s not really transaction-based processing,” Yong said. “Claims submission goes a step further with a large number of edits.”

The doctors’ offices submitted claims on paper forms to HPSM before Web Claims was available, Yong added. “This solution is not being targeted at the high-volume submitters. We don’t expect them to sit at a Web browser for hours keying in claims.” Web Claims is for the small- to medium-sized providers, turning in fewer than 500 claims a month, who can’t invest the money in a batch submission solution. Web Claims gives a doctor’s office real time eligibility reports. Claims submitted are processed four nights a week from a batch area.

Speedware’s engineers did the development using Autobahn, the company’s rapid development tool for Web applications on HP 3000s. Yong said that Speedware was working to eliminate the prerequisite for NetManage when using Web Claims.

HPSM uses a PC-based Web server to interact with its providers, and that server communicates with the HMO’s Series 996/300 HP e3000. The HMO works with about 1,200 providers while covering its 40,000-member insured base. The providers can submit HCFA-1500 forms and drug forms, which has let HPSM virtually eliminate paper costs: printing forms, keeping them in inventory, distribution and filing.

“Overall, our transition to e-billing has been easy,” Yong said. Speedware’s consultant installed the environment, extended NetManage and coded the application’s Web screens in HTML. The HPSM staff has been working with Amisys claims since 1994, and “with our understanding of the business and of Amisys, and [his] understanding of Autobahn and Web design, it was fairly well taken care of,” Yong said.

Speedware will be selling the solution with some customization for other health plans, Yong said. The match of the e3000 and Speedware’s Web capabilities delivered reliable results. “You put HTML pages on the e3000 itself, and they get served up to our PC Web server by Autobahn,” he said. “It’s just like any other Web system, in that it’s totally transparent to the end user.”

HPSM has leapfrogged HBOC in developing a Web-based claims submission module for Amisys — something Yong thinks HBOC “is upset about, because we beat them to market.” HPSM wanted to do a cross-marketing agreement with HBOC on the project, but couldn’t get any interest from the vendor after the development was done. Speedware stepped in to offer Web Claims to the market, and will keep the project up to date.