Benefits and Challenges of EHR at Blue Shield CA FEP

Benefits and Challenges of EHR at Blue Shield of CA Federal Employee Program (FEP) Christina McClenaghan National University

Benefits and Challenges of EHR at Blue Shield CA FEP Abstract

Blue Shield of CA Federal Employee Program is constantly improving processes to make health insurance payments, benefits and claims processing easier to access for both providers and members of their insurance plans. Blue Shield of CA FEP relies heavily on EHR (Electronic Health Records) to disseminate information to providers such as physicians, hospital and professional billing staff, members, and other health care professionals. Using EHR is a main focus of claims processing at Blue Shield of CA FEP and claims processors and customer service representatives have seen the benefits of EHR implementation and had to work through the challenges of implementation as well. EHR systems are costly to implement. Patients have concerns that electronic access to their health information puts their privacy at risk. Providers worry that they could be held financially accountable for breaches in patient privacy if there are violations of the Health Insurance Portability and Accountability Act (HIPAA). On the other side of the coin, having information that can be easily accessed by providers and patients has been beneficial. EHR systems, such as the Provider Portal have allowed providers to seek information on benefits, eligibility and claims status on their own at their convenience. Patients can find providers in their network and get the status of submitted claims by performing online searches after business hours when a customer service representative may not be available. (Tan, 2010)

Benefits and Challenges of EHR at Blue Shield CA FEP Benefits and Challenges of EHR at Blue Shield of CA FEP At Blue Shield of CA FEP Electronic Health Records (EHR) are an important part of everyday business processes for employees, providers and members. By using EHR to capture patient data and payment information Blue Shield is able to streamline processes. Blue Shield has also used EHR as a tool to create access for providers and members through access Portals

which allow for ease of collection and dissemination of information with the goal of making both providers and members happier and increase their ability to find answers to questions related to benefits, copayments, claims status and other related information at their convenience. EHR implementation is also challenging. One of the major challenges that any organization faces when implementing an EHR system is the high cost of implementation. Many physicians groups have tried to implement lower cost EHR systems only to find that they are dissatisfied with the vendor or the system needs to be replaced (Treasure, 2012). For Blue Shield of CA, this process took years to complete because they designed their own system. Infrastructures must be built and information inputted. When going from paper billing records and insurance claims, the data all needed to be converted and loaded into the EHR system. Blue Shield of CA FEP relies heavily on scanning paper documents such as prescriptions, patient records, explanations of benefits and member and provider correspondence. This allows for greater accessibility once the image has been scanned and uploaded into a viewing program. One of the challenges associated with this process is scanning the images and tagging the images so they can be easily found in the system is a time consuming process. Due to strict privacy laws regarding protected health information (PHI) Blue Shield of CA FEP does not allow members or providers to email information that could be readily inputted into the image viewing program. Blue Shield of CA FEP does not yet have the procedures in

Benefits and Challenges of EHR at Blue Shield CA FEP

place to ensure that incoming electronic correspondence would be free of viruses that could harm the internal network. One way that Blue Shield of CA FEP is trying to improve this process is through the use of portal systems that can be accessed by both providers and members of its insurance plan (Provider Connection, 2012). The portals allow for increased security to ensure that Blue Shield CA remains compliant with HIPAA laws. Portal access requires that members and providers register their information and create individual usernames and passwords. In this way Blue Shield can be in control of who has access to its systems and how information is relayed into the network. One benefit to providers of the portal, called the Provider Connections, is that it allows them access to up-todate eligibility and benefits information for their patient. This access allows provider billing representatives to verify benefits and see if a patient has met their deductible or out-of-pocket maximum keeping them current with what the patient responsibility would be for the services they will be billing for (Provider Connection, 2012). MyBlue, a web based member portal for Blue Shield of CA Federal Employee Program (FEP) subscribers, is designed for patient access. After creating a unique member id and password for login purposes, members are able to update their personal health record, find status of their claims, eligibility and benefit information, and see if prior authorization requests for medical services have been approved. Upon completion of a one-time registration through the MyBlue portal, members then have unrestricted access to partner sites such as CVS Caremark, Blue Shield CA FEPs retail pharmacy vendor, MyBlue Customer eService, and Blue Health Connection with the convenience for members of only having to remember one username and password (FEPBlue.org, 2012).

Benefits and Challenges of EHR at Blue Shield CA FEP

Single Sign On (SSO) works by verifying an individual member with a unique username, password and email address. Login IDs for the individual member sites are not the same as the MyBlue portal ID and do not allow for the same unrestricted experience when moving between sites. For privacy and security purposes, each member must register individually for access to MyBlue portal. This ensures that PHI is not released to other members of the family who may be enrolled under the same subscriber id number or family policy without the proper authorization and keeps Blue Shield of CA FEP compliant with all laws and regulations pertaining to the release of its members health information (FEPBlue.org, 2012). Electronic Health Records (EHR) is costly and time consuming to implement. It must be designed to meet the individual needs of the organization that will be using it. Blue Shield of CA FEP has had great success in using EHR to streamline customer service operations and give convenient access to claims, payment, prior authorizations and eligibility information to participating health care providers. Members can view their current benefits, prior authorizations, deductible amounts, out of pocket costs and also have access to a number of partner sites when using the MyBlue Single Sign On (SSO) id (FEPBlue.org). By streamlining access for both providers and members to the information they need allow them to make more timely decisions regarding their healthcare and keeps the relationship between Blue Shield of CA FEP and the members and provider that the serve strong and running smoothly. For Blue Shield of CA FEP the rewards have outweighed the costs when implementing EHR.

Benefits and Challenges of EHR at Blue Shield CA FEP

References Blue Shield of California. (2012) Provider connection. Retrieved from https://www.blueshieldca.com/provider/home.sp Blue Cross Blue Shield Federal Employee Program. (2012). Retrieved from https://www.fepblue.org/web/guest/myblue?resume=https%3A%2F%2Fsso.fepblue.org %2Fidp%2FstartSSO.ping%3FPartnerSpId%3DFEP_SSO_SP%26TARGET%3Dhttps% 3A%2F%2Ffep.careenhance.com%2Fportal%2Fsite%2Ffep%3Fssodeeplink%3DPHR Tan, J., & Cobb Payton, F., Adaptive Health Management Information Systems. Sudbury, MA. Jones and Bartlett Publishers. Treasure, K. (2012) Avoiding Costly EHR Mistakes. Retrieved from http://www.health2news.com/2012/09/11/avoiding-costly-ehr-mistakes/