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The Frustration of Claim Attachments: Three Troublesome Scenarios Solved

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If you’re not currently using electronic claim attachments, NEA Powered by Vyne has no doubt that you’ve likely experienced one of these three common claim attachment scenarios:

  1. Claim attachments getting lost in transit and never received by the payer
  2. Delayed response times for predeterminations
  3. Unclear, unacceptable radiographs

The frustrations brought forth by these scenarios and their inefficiencies turning what should be routine tasks into unnecessary “emergencies” can cause a myriad of issues for dental practice personnel. The good news is that these issues can be easily overcome by using FastAttach® – a secure, 100% electronic claim attachment solution from NEA.

According to empirical research done by NEA at conferences and meetings across the country, by far, the number one frustration we’ve heard is related to being told that a radiograph is needed and hasn’t been received even though you know it was already mailed with the claim.

  • One thing you could do to be proactive is to make sure you’re only sending attachments that are required and not sending unnecessary attachments “just in case.” By using FastLook™ from NEA, a free tool offered along with every FastAttach subscription, you can search by dental plan/payer and procedure code to see what, if any, attachments are required BEFORE you submit your claim.
  • To avoid mailing original or duplicate radiographs with your claims and “hoping” they get to the payer, you could simply use FastAttach and send them electronically. It’s fast, secure and inexpensive and you can track what was sent when and to whom for which claim.
  • Even practices that are not digital, can take advantage of FastAttach to send x-rays and other images to support claims. By using FastKapture® (a free, secure mobile app also from NEA,) you can simply take a photo of your images with any smart mobile device then electronically transmit it via Fast
  • Images transmitted using FastAttach are securely stored for easy retrieval and a confirmation report that the image was uploaded along with an NEA tracking number is generated at the time of transmission. This empowers you with a tracking mechanism for every claim attachment you send, so you have irrefutable proof that the claim attachments you say you have sent were indeed sent to a payer.

The second most common frustration we’ve heard is the amount of time that it takes to get a reply on predeterminations. It is different at each payer, but in general most have steps similar to the following:

  1. Provider mails paper claim form with a radiograph requesting predetermination.
  2. Payer receives the form and radiograph in the mailroom.
  3. The form is scanned into an Optical Character Recognition (OCR) system essentially making it an electronic claim without a date of service.
  4. The claim is notated as having a radiograph. This is fine, but the radiograph is still a separate piece of film in many instances.
  5. The claim is very likely transmitted to another location and queued into a batch.
  6. In a perfect world, the radiograph is put in an interoffice pouch and mailed to the correct center where the claim was queued.
  7. Individual consultants work the queue and have to match up the radiograph with the claim.
  8. The consultant makes the determination and creates a message to be mailed to the provider on an explanation of benefits (EOB).

Even if everything goes exactly like it should with all these steps, it would still take very a long time to get a response. The reality is that we do not live in a perfect world, and people make mistakes. When you have this many steps, the odds of something getting lost, misplaced, mistyped, misread, etc. are very high. The best solution is to reduce the odds of something going awry by automating and reducing as many of the above steps as possible. Let’s look at what happens when you use FastAttach to electronically transmit everything:

  1. Provider transmits the electronic predetermination and radiograph.
  2. Payer receives the electronic predetermination and automatically queues it to a processing center.
  3. Individual consultant works the queue and views the radiograph in a digital format on a secure web site.
  4. Consultant makes the determination and creates a message to be sent to the provider on an EOB.

That’s half as many steps that are required for the same result, so realistically you could reduce this process from one that takes weeks to one that takes only days just by using FastAttach.

The third – and biggest point of frustration we’ve heard is one where a radiograph is printed on paper and mailed with a claim, then a couple of weeks later, an EOB comes in the mail saying the claim is being denied because the image was not clear enough. Having purchased an expensive digital imaging system that was supposed to replace film radiographs completely and make life easier has instead created even more frustration. The good news is this situation is actually the easiest of all to remedy.

  1. You already have a digital image of the radiograph, which looks fine on your computer monitor. Why not take the next logical step toward a paperless office and electronically transmit that image to support your claim using FastAttach?
    • You can upload the image or – even easier still – simply take a screen capture of the image and send that as the attachment.
    • With a screen capture, you can adjust the image quality and not have to worry about uploading a large digital file.
    • Either way, the payer will see a copy of the image that you have on your computer, which they can enhance brightness, contrast on, etc.
    • The image transmitted cannot be altered, because it is locked.
    • The image is received and confirmed in seconds.
    • You have a tracking mechanism.
    • Your claim can be processed faster.
    • If there is a question about the image, you can look it up via FastAttach with the tracking number. You can even view it at the same time with a payer so they see what you’re seeing.

After reading the scenarios above, you can clearly see how using FastAttach for the electronic transmission of claim attachments can greatly improve the efficiencies of an office. This process automation and improvement will in turn reduce the number of unnecessary “emergencies” to be handled by your staff leaving them more time to spend on tasks directly related to patient care and growing your practice.