Obtaining and verifying referrals via NaviNet has never been easier for Berlin Medical Associates

New Jersey-based Berlin Medical Associates (BMA) is a multi-specialty practice with eight providers treating more than 250 patients a day. The practice offers a comprehensive approach to the diagnosis, treatment and management of both the individual patient and the family, delivering a full range of services to its patients. BMA physicians and staff are committed to providing the highest quality care to their patients within a compassionate and friendly setting.

In specialty practices, most patients need referrals prior to treatment and managing those referrals is especially time consuming. The administrative staff at BMA found the process of verifying referrals to be inefficient and labor intensive, often requiring staff to look up primary care physician information in a phone book and log calls to insurers and other offices. One referral verification could take up to 15 minutes to complete. Additionally, because many referrals received were hand written, the paper clutter began to accumulate in patients’ files, taking up a large amount of the limited office storage space. As the practice continued to grow, the staff knew they needed to find a quicker, more efficient way of navigating the referral process, or they would end up buried in paperwork and overloaded by phone calls, unable to provide their patients with the quality of care and attention they deserve.

Saving time by obtaining and verifying referrals online

Berlin Medical Associates began using NaviNet Insurer Connect to address the challenges of obtaining and verifying referrals. Insurer Connect enables the practice to securely connect electronically with the leading health insurers in the regions that cover their patients. Insurer Connect is offered by health insurers at no cost to providers and enables BMA to communicate with several insurers from a single Web site. BMA uses NaviNet to connect with Aetna, AmeriHealth Mercy and Horizon Blue Cross Blue Shield of New Jersey. Using NaviNet, BMA staff can search for the status of referrals and quickly determine if the insurer has authorized care even before the patient comes to the office for an appointment.

Jeanne Rosser, office administrator at Berlin Medical Associates, explains: “With electronic access to our patients’ insurers through NaviNet, obtaining referrals is dramatically quicker and easier. We eliminated the need to find patients’ files, look up primary care physician and insurer information, and manually make calls for verification.” Rosser continues, “The entire process now takes less than two minutes per referral. NaviNet has become such an important tool in our daily activity— we complete between 40-50 referrals daily and always have at least one person using NaviNet for a minimum of four hours every day.” In the practice, referrals that would have taken between 10 and 12.5 hours each day can now be completed in less than two hours with NaviNet.

Electronic transactions improve provider and patient experience
Not only does the use of NaviNet significantly expedite the process of referrals, real-time access to patient information improves the practice’s patient relations. BMA also uses NaviNet to look up patients’ insurance eligibility and benefits, and to receive care authorizations (precertifications). “The ability to use NaviNet to quickly pre-certify treatments for existing patients and to check the insurance eligibility and benefits of new patients enables us to make these inquiries an important first step in the patient check-in process,” says Rosser. Since the practice conducts many specialized tests and treatments, which can often be costly, the staff can determine if a patient is covered by insurance, and how, before providing care. “Knowing what type of insurance a patient has in advance of the appointment ensures that patients won’t get hit with a big bill or service that wasn’t covered by their insurance, improving the patient experience,” Rosser explains.

With information retrieved through NaviNet, BMA can provide patients with written documentation from an insurer with an explanation of coverage and/or reasons for denials or changes of a procedure. This results in more thorough conversations about care delivery. Further, having a record of all referrals along with up-to-date insurance information validates the need for the care provided. “If a patient is denied coverage, our administrators have the information they need to act as an advocate for their patients and communicate with the insurer about the denied claim,” says Rosser.

The benefits BMA has seen with NaviNet are unmatched, and include cost savings, time savings and improved patient relationships. “If our practice didn’t have NaviNet, we would have to employ another fulltime administrator to process referrals manually,” Rosser says. “NaviNet has become such a critical part of our daily workflow, I can’t imagine our office without it!”