BOSTON, Mass. — Two of the biggest names in Massachusetts health care say they want to take the wait out of getting insurance sign-off for scans. Blue Cross, the not-for-profit health plan based in Boston, joined with Tufts Medicine on Thursday to announce a broad partnership that starts with speeding up prior authorization, the step in which a doctor must get the insurer’s approval before certain tests.
Tufts Medicine will use software from Humata Health, a company now owned by R1, to send those requests for Blue Cross members. The first service in line is outpatient imaging such as MRIs, with more types of care to follow. The goal is to swap a process that can drag on for several business days, often with faxes and manual reviews, for one that returns an answer in minutes.
The data moves over a regional exchange network run by the Massachusetts Health Data Consortium, which both groups plan to use for referrals and claims as well.
The deal also creates a new HMO, the Tufts Medicine Alliance Network, that Blue Cross will first offer to its own workers during open enrollment. It promises members a next-day primary care visit and a Tufts Medicine specialist within 21 days. The network’s hospitals include Tufts Medical Center, Lowell General, MelroseWakefield and Lawrence Memorial in Medford.
The two organizations also plan to work on payment models tied to quality and on more after-hours, mental health and virtual care, building on Tufts Medicine’s long role in the insurer’s Alternative Quality Contract.
Filed under: Boston MA Health News
