Automated network spans the nation; Tri-Care computerizing to improve the efficiency of processing health-care claims.

• Position: Company of the Year 51+ employees - Northern Ontario Business Awards Thunder Bay 1990 - Company profile

Automated network spans the nation

On the sixth floor of a downtown Sudbury office building sits a computer which will eventually process a majority of the nation's group health insurance claims.

The $12.9-million electronic claims-processing system is being phased in over the course of a year. It will enable health-care professionals to access data on a patient's benefit package via computer.

The system, called HealthNet, is an integrap part of the operations of the Tri-Care Group of Companies, this year's winner of the Company of the Year Award (51+ employees) which is sponsored by the Royal Bank of Canada.

Tri-Care provides administrative services to more than 64 per cent of the major health insurance companies in Canada. It provides the same service to 140 corporate insurers which include the Toronto Dominion Bank, Consumers Distributing, Falconbridge Ltd. and Purolator Courier.

The accounts represent $33.5 million in total annual premiums.

The Tri-Care group consists of four separate companies. Robert Morel is president of the parent company, Tri-Care Services Ltd., and is chief executive officer of member companies Directcard Identification Systems Ltd. (Rx Plus), Multi-Care Systems Ltd. and HealthNet Systems Inc.

Each of the three subsidiaries has a role to play in the processing of claims. Directcard administers pay-direct drug plans; Multi-Care links the system with computers in pharmacies, hospitals, dental offices and optical dispensaries; and HealthNet is the coast-to-coast computerized communications network.

Incorporated in 1982, Rx Plus is Canada's largest third-party claims processor. Morel anticipates it will make payments totalling more than $75 million this year on behalf of insurers.

According to a report prepared by Rx Plus, as of April there were approximately 200,000 Rx Plus card holders, representing an estimated 530,000 Canadian residents.

Of the approximate 6,900 pharmacies in Canada, Rx Plus has contracts with 6,320, incuding 2,321 in Ontario alone. The company's major competitors are Blue Cross and Greenshield.

The automated HealthNet system is approaching full...