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BLOG: The Role of Attachments in the Electronic Claims Process

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The healthcare industry is becoming increasingly efficient by digitizing electronic patient medical recordsmedical claims, and insurance claim documentation.  An important part of this electronic shift is electronic attachments, such as those that include supporting documentation for electronic claims.  Not only can submitting claim attachments electronically save money and time, but soon there will be specific government regulations requiring their use for specific procedures or events.

The upcoming requirements will require payors to accept six types of medical electronic attachments in a standardized format.  These include lab, ambulance, emergency department, rehabilitation, clinical, and medication reports.  By making this process paperless and standardized, medical documentationcan be included with the initial electronic claims submission thereby eliminating paper out of the claims submission process.

There are a number of recognized benefits gained from the electronic submission of attachments for both providers and payors.  The savings in time, paper, and postage alone can result in increased ROI.  Providers will see fewer denials and rework requests typically seen with failures to provide additional documentation, and Payors will have fewer claims pending while waiting for documentation requests.  Another way to save time is submitting all supporting documentation that is often requested by payors for specific procedures, with the initial claim; referred to as an unsolicited attachment.  Additionally, the number of claims that an insurance reviewer can process in a single day is limited by the amount of paper they have to wade through; experiences has shown that an electronic attachment solution results in the number of processed claims increasing without an increase in staff.

Although attachments only represent a small part of the electronic claims process (applicable in perhaps 10% of claims), their impact on the speed of reimbursement can be significant.  Since patient medical records are typically filed in digital format, including attachments with a medical claim is only a matter of an extra mouse click or two.  This is in contrast to printing and mailing claims and attachments, which takes time preparing and sending, and then the payor opening, indexing, and sorting before even landing on the right desk.  NEA’s clients have reported reducing their outstanding receivables by 10 to 14 days by including electronic attachments with their electronic claims submissions. With new government mandates just around the corner, we are on the cusp of a new era in electronic claims. Changes in healthcare policy will come quickly, and thought leaders will put new processes in place now.  Why wait?