Speeding Up Claims Adjudication with Electronic Attachments

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The shift to digitized business practices in the healthcare industry has heralded in increases in efficiency on many fronts besides just patient care. Something else that is important to every patient is insurance claim reimbursement. Healthcare providers are committed to making this process as quick and painless as possible, which means that every bit of increased efficiency helps – particularly in the potentially lengthy claims adjudication process. Keeping things as simple and streamlined as possible is important, and electronic attachments are one step in the right direction.

It is the task of the payor to determine what will be paid on a medical 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 process can be lengthy, particularly if it requires documentation to be printed, prepared, mailed, received, opened, indexed, and sorted before it can be reviewed. This is where electronic attachment submissions 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 the claims adjudication process. Besides the time in the mailroom, further delays occur when payors delay claims by soliciting further attachments. Solicited attachments can be requested two to four weeks after the initial claims submission. By adding electronic attachments to the electronic claims submission process, payors can shorten this cycle and speed up claims adjudication.

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 processed as quickly as possible. Thanks to the new era of digitization in healthcare, attachments are one way to streamline and save.