Many state health agencies would be thrilled to receive 85 percent of their Medicaid claim forms electronically, as the Washington State Department of Social and Health Services does. For DSHS officials in this tech-accomplished state, however, anything less than 100 percent is unacceptable. And so the agency is embarking on a marketing campaign to persuade the remaining 15 percent of providers to make the switch from paper to online filing.

"We've been calling them, visiting them, doing anything that they desire," says Chris Johnson, claims processing manager. "If they need somebody to sit down next to them and walk them through it, we will do it."

It all comes down to money. With the agency's budget being squeezed, the issue of paper-versus-electronic filing is no small matter. Each paper claim costs DSHS more than $1 to process, while electronic claims cost about 10 cents. Johnson estimates that nearly 60 percent of her staff's salaries can be apportioned just to dealing with paper claims.

Of the 15,000 health care providers that still file on paper, the state is initially targeting the top 100 billers. In addition, the state is reaching out to the vendor community, trying to persuade companies to develop electronic filing software or to encourage their clients to file electronically.

Electronic claims can be filed on the Web, through private software or by portable filing stations. "We don't care who gets the credit," Johnson says. "We just don't want the paper."