What Is the Impact of Computers & Health Insurance?

The combination of computers and the health insurance industry has had significant impacts. Health insurance enrollment is no longer restricted to a paper-based system. The electronic transmission of insurance data and payment information can become caught in fraud schemes. Consumer protection is essential and provider regulations are more strictly enforced.

Administrative Support

• Enrolling in health insurance is made easier

  The integration of computers into the health insurance system has benefits. This is evident by the progress with the insurance enrollment system. It is no longer necessary for an individual to complete a lengthy paper-based application form in duplicate. Insurance companies offer online and electronic enrollment forms that allow for enrollment in a more streamlined fashion, and offer options for support both through online messaging as well as telephone support. The ability of the computer system to support and ease the process of enrolling in health insurance program leads to increased member satisfaction.

Insurance claim fraud

• Insurance fraud continues

  Insurance companies can use computer applications to detect and respond to insurance claim fraud and error detection. This can help to reduce the costs that are associated with fraud. According to the National Health Care Anti-Fraud Association, in 2007 the United States spent more than $2.2 trillion dollars on healthcare and more than 4 billion health insurance claims were processed. The National Health Care Anti-Fraud Association estimates that more than 3 percent of health care spending is lost due to fraud. The ability to detect potential fraud situations, respond in a timely manner, and potentially recover lost dollars is invaluable.

Protection

• Security measures protect health information

  The use of computers in health insurance has contributed to additional layers of security and protection. An individual that is attempting to access his insurance information using a computer and Internet connection may be required to enter a login and password to be able to access his account. The inability to provide a correct login and password can result in a temporary suspension of access to the computer. This type of response is critical to avoid illegal account access and it also protects the individual's personal health information.

Accountability

• HIPAA support accountability

  The combination of computers and health care insurance companies is not novel. In 1996, the U.S. Department of Health and Human Services orchestrated the development of the Health Insurance Portability and Accountability Act, which is commonly referred to as "HIPAA." HIPAA is a comprehensive act that impacts several aspects of health insurance and computers. Examples include standards on the electronic transmission of health claim attachments, health claim status, and health care payment advice. Health care systems and providers that do not follow HIPAA guidelines are subject to a variety of consequences, including financial penalties.

Insurance coding

• Accurate coding is critical

  Computers reduce health claim insurance turn-around and processing time. The data that is entered into the computer influences the overall processing of the claim. When data is entered into a computer program even seemingly minor errors can have significant consequences for the patient, the provider, as well as the payer or insurer. If an incorrect diagnosis code is entered, this can lead to a cascade of misinformation developing. A patient's diagnosis may be incorrectly submitted to the insurance company leading to a higher or lower payment to the provider. Accurate data entry is essential for complete and thorough insurance coding and claim processing.