As a dental practice leader who understands the importance of process automation and data security, you’ve taken the necessary steps to implement what you’re certain is a secure, electronic claims and attachment process. But how can you be sure the claims documentation you’re submitting is making its way to the health plan or payer in a likewise secure fashion?
Even if you are using an outside clearinghouse for the process, there is a very good possibility that not all of your claims and attachments are being processed electronically even if that’s what you’re expecting from the partnership. Some clearinghouses drop claims and attachments to paper more than you think, so much so that it’s called “drop shipping.”
For example, you send your claim attachments to your vendor electronically, then, unbeknownst to you, they print the claim attachments and supporting documents then package and send them to the payer on your behalf. This sort of thing happens every day at clearinghouses; for some it’s standard operating practice.
According to dental practice consultant Teresa Duncan, MS, FADIA, FAADOM, founder of Odyssey Management, “Everyone assumes all clearinghouses have direct (electronic) lines to all payers and that’s not true.” Thus, not every clearinghouse has the needed electronic connection to payers so they must drop claims and attachments to paper, pack them up and send them via carrier to the payer, Duncan says.
Doing so eliminates an audit trail and makes it nearly impossible to track the claim and provide supporting documentation that may be required for payment.
Duncan advises practices to verify which payers their vendors are electronically connected to by asking for their payer lists. If the vendor won’t provide the information, practices leaders should be wary of the clearinghouse, she says.
Choose your vendor wisely. If a vendor doesn’t have electronic payer relationships in place, there is no choice but to drop the claims and attachments to paper. Duncan, a former dental practice employee and office manager for more than 20 years, says that often, the vendor tells practices that they’re taking it off their hands, but that’s not always the case. “When I hear that I assume they’re an electronic clearinghouse and it’s all going electronically,” but, as more people try and get into the claim attachment space, they’re being less open about how they’re submitted all of the claims and attachments they’re sending.
Practices should do their own due diligence and ask clearinghouses if they electronically connect to their payer’s claim and attachment repositories. If a vendor doesn’t have capable resources to adequately submit most or all claims and attachments electronically from a claims attachment solutions like FastAttach, to payers, the practice should reconsider using the services of that particular processor.
To identify potential problems:
- Look for patterns in aging claims
- Closely investigate any sudden increase in claim denials
- Examine whether you are consistently having to resubmit to one particular insurance company
- Determine if you receive repeated requests from a payer for additional information
If you experience each or all of these regularly, there’s a good chance your clearinghouse is dropping your claims and attachments to paper. There is little reason that you shouldn’t be able to submit 100 percent of your claims and attachments electronically. FastAttach from NEA Powered by Vyne is the ONLY 100 percent electronic claim attachment solution in the industry. With more than 20 years of experience building solutions and relationships that enable us to provide electronic connections to over 750 dental plans and payers, NEA never drops anything to paper – we never have and we never will.