It is the task of the payor to determine what will be paid on amedical claim, but it is a decision that often involves requests for supporting documentation or even entire patient medical records from the provider. The claims adjudication processcan be lengthy, particularly if it requires payors waiting for documentation to be printed, prepared, mailed, received, opened, indexed, and sorted. This is where digital attachments come in.
Though attachments are only applicable in a portion of medical claims (perhaps ten percent), they have been shown to have a significant impact on the speed of reimbursements, because soliciting and preparing paper attachments slows down theclaims adjudication process. Besides the time in the mailroom, further delays occur when payors delay claims or solicit further attachments. Solicited attachments can be requested two to four weeks after the initial claims submission. By adding digital attachments to the electronic claims submission process, payors can shorten this cycle and speed up claims adjudication. In fact, MEA|NEA’s clients have reported reducing their outstanding receivables by 10 to 14 days.
If additional documentation is available with the initial claim submission, when payors begin claims adjudication they will already have all the information they need to process the claim on the first pass. Without having to take the time to make further document requests, payors can adjudicate all of their claims electronically – and thus more quickly and less costly.
The truth is that insurance reviewers only have so much time in a day, and this time is limited by how much paper they have to wade through. Any increase in efficiency in the claims adjudication process will increase the number of claims they can process (without an increase in staff) and result in a quicker turnaround for providers and patients. Additionally, electronic documentation via attachments has been shown to result in fewer denials and rework requests, particularly since the typical cause for these delays is a failure to provide required or requested documentation.
When it comes to claims adjudication, all sides want to see claims adjudicated as quickly as possible. Thanks to the new era of digitization in healthcare, attachments are one way to streamline and save.