The operator of the Envoy clearinghouse for electronic health-care claims processing says it's enhancing its ability to monitor claims tracking and implementing new tools to more quickly detect when a transaction fails.

Charles Babcock, Editor at Large, Cloud

January 28, 2004

2 Min Read

WebMD Corp. has had "isolated and sporadic problems" in processing electronic health-care claims through its Envoy clearinghouse, says a spokeswoman for the company, but the problems were not "national or systemic."

The acknowledgement from WebMD is in reaction to a letter of complaint from the American Medical Association and other medical societies, a copy of which published yesterday. AMA members had complained that WebMD, the operator of Envoy, one of the largest clearinghouses for claims processing, was losing their claims, processing them erroneously, or failing to notify them of rejected claims. Many of the complaints came from doctors' offices in Arkansas, Colorado, Iowa, Kentucky and Texas, states whose medical societies were signers of the letter.

The medical societies had reported an upsurge in complaints since the Health Insurance Portability and Accountability Act (HIPAA) regulations went into effect on Oct. 16. WebMD says it's seeking a meeting with representatives of the AMA and other signers of the Jan. 8 letter. "We have really devoted tremendous resources to the transition" to make claims processing compliant with HIPAA, the spokeswoman says. "We send millions of transactions across the country in HIPAA-standard format every day," she says. Many of the claims go through a central switching facility at Envoy headquarters in Nashville, Tenn.

To counter the complaints, WebMD is "working to enhance our ability to monitor and track all claims transactions." The company is "deploying new tools and resources" for early detection when a transaction failure occurs, she says.

WebMD also is instituting an electronic newsletter that it will send to physician offices "to keep providers informed of current issues," the spokeswoman says. "We have really made steps to prevent and rapidly resolve these problems in the future."

The AMA letter said claims representing "thousands, and in some cases, hundreds of thousands of dollars" to physicians' practices had been delayed, lost, or erroneously processed.

About the Author(s)

Charles Babcock

Editor at Large, Cloud

Charles Babcock is an editor-at-large for InformationWeek and author of Management Strategies for the Cloud Revolution, a McGraw-Hill book. He is the former editor-in-chief of Digital News, former software editor of Computerworld and former technology editor of Interactive Week. He is a graduate of Syracuse University where he obtained a bachelor's degree in journalism. He joined the publication in 2003.

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