Through this innovative exchange, health insurance companies will provide their group plan customers with extensive Web-based claims capabilities. Individual plan members will be able to easily access and complete forms electronically; securely submit the completed claims forms for eligibility verification, processing and adjudication; receive explanation of benefits; and, confirm payment to their personal bank account.
This innovative exchange will be a turning point for the life and health insurance companies. It will allow them to truly experience the many advantages of moving from a paper-based system to a fully secure and web-enabled one, said Ron Loucks, Executive Vice-President, e-Health Solutions Group – North America, BCE Emergis. Building on our existing relationship, Clarica has been great in helping to conceive and develop this leading-edge e-commerce tool for the insurance industry. From a cost savings and customer experience perspective, this exchange is such a compelling solution that we believe other health insurance companies will want to join over the coming months and it will generate interest beyond our borders.
Barry Triller, Clarica’s Executive Vice-President, Canadian Customers, said Clarica is dedicated to constantly improving customer service through innovation and partnership. We recognized the immense business potential of this exchange and seized the opportunity of working with BCE Emergis in its design and creation. The exchange marks the beginning of a new era for our industry. It will allow us to provide greater convenience and faster service to our customers while reducing costs.
According to the Group Universe Report published by The Fraser Group, the 1999 group health claims market in Canada totaled approximately $9.2 billion, of which Clarica has a 10% share. Clarica is the first large insurance company to partner in the e-health claims exchange, which is expected to add other insurance companies over the coming months.
As initial founding partner, Clarica will invest in the exchange and, for an initial term of five years, use it for all of its health and dental claims. Also, Clarica will have an active role in the continued development of the exchange by providing expertise and resources to conceive of, improve and test the systems as they are developed.
BCE Emergis has designed and will develop, build and operate and own the Web-enabled systems that will process the health and dental claims for group insurance benefit plans. These will include an integrated claims adjudication engine as well as payment methods such as electronic funds transfers (EFT) and traditional cheques. The exchange will generate recurring transaction revenues for BCE Emergis since its technology is powering the systems.
This comprehensive claims exchange will enhance business processes by providing claims management using Web-based tools and software and will provide continually evolving value-added capabilities. With its extensive functionality, the exchange will dramatically accelerate the claims processing and reduce its cost, ensuring individual plan members the ease of web-claim filing and faster refunds. For employers, the exchange will reduce the costs of processing and adjudicating claims. Health claims will include drug, dental, vision, hospital, supplementary health care, out of country and health care spending account claims.
The first phase of the e-health claims exchange will go online by the end of May this year. Functionality will expand over the coming months, with the exchange becoming fully functional at the end of 2002 for all health insurance companies involved.
