Electronic Medical Claim Attachments: a Major Opportunity for Saving Time and Money
Written by: Carrie Murphy, Director of Solution Management, Veradigm and Cheryl Reifsnyder, PHD
A recent study from Crowe RCA showed that denials rose to 11% of all claims in 2022, up nearly 8% from 2021—and the cost of those denials rose 67%. One of the primary reasons behind denied claims is insufficient or inaccurate documentation. In the past, most of these requests for additional documentation have been handled manually—by mail or fax—and often after the initial claim transactions were already delivered to the payer, further delaying the reimbursement cycle.
Changing marketplace and regulatory conditions have brought about health plan innovations such as real-time adjudication processes and expedited multi-tiered payment models, both requiring timely documentation to avoid costly delays for both payers and providers.1 With the escalating demand for providers to supply timely and efficient documentation to commercial and government payers, finding a more efficient means of handling these documentation requests has become imperative.
Veradigm Payerpath now offers a solution: the Veradigm Payerpath Medical Claim Attachment solution, which gives payers and providers a robust tool for single-platform management of medical claim attachments.
The problem
Attachments are a major cost and operations issue for both payers and providers, one that can cause significant process delays on all sides. Only 22% of payers received attachments electronically in 2020; nearly 8 out of 10 health plans relied on a fully manual process for attachment management.
Manual processes require more time and cost for both payers and providers. When a provider manually delivers requested information, they have no way to connect it to the relevant claim. On the receiving end, the payer lacks the means to immediately associate information with the appropriate claim. This requires payers to spend time connecting attachments to claims, creating delays that can significantly impact patient outcomes.
Benefits of electronic attachments
Electronic attachments can streamline the claims management process for payers and providers alike, creating both time and dollar savings.
Payers are estimated to receive over 2 billion claims per year from providers, 4% of which—or about 80 million—require attachments. A recent report estimates that requesting, receiving, and processing attachments costs payers more than $20 per attachment. According to the 2022 CAQH Index report, 76% of attachment transactions in 2021 were carried out manually, representing a potential cost savings of over $200 million for the medical industry.
Automating claim attachments could save providers an average of 5 minutes per transaction—or about 400 million minutes nationwide in 12 months.
Veradigm Payerpath Medical Claim Attachment solution
Veradigm Payerpath is a web-based solution that streamlines every step in the reimbursement cycle, from eligibility verification through patient collection. Now, Veradigm’s Payerpath Medical Claim Attachment solution supplies providers with a robust solution for managing medical claim attachments from a single platform. This solution facilitates the exchange of key information needed to review and adjudicate claims.
The Veradigm Payerpath Medical Claim Attachment solution utilizes flexible technology that enables practices of all sizes to leverage existing IT technology, resources, and connectivity to automate their attachment workflow process. Veradigm’s solution integrates claim adjudication, payment, and documentation management solutions, helping to reduce operational costs while providing attachment integration with hundreds of payers using a variety of attachment submission methods. Secure, electronic delivery eliminates mailroom costs, such as scanning, indexing, and document storage, while helping you expedite claim adjudication.1
Payerpath’s medical claim attachment solution can help payers and providers to:
- Establish a delivery audit trail for medical claim attachments
- Reduce duplicate submissions and requests for information
- Leverage flexible formats such as X12, images, and other emerging technologies
Commercial and Government payers alike can take advantage of Veradigm’s unique experience, scale, and expertise to enable effective and efficient delivery of attachment files:
- In the required format
- With the required indexing
- With the ability for automated ingestion into their claims review processes
- With minimal impact on IT resources
The Veradigm Payerpath Medical Claim Attachment solution is powered by Jopari, which has experience processing more than 1 million medical attachments monthly. Veradigm’s solution utilizes the same these document exchange tools that providers have been using for years to send millions of attachments each month to Workers’ Compensation and Auto Medical Payers.
Stakeholders’ reported results
Using the medical claim attachment solution, Jopari clients reported notable improvement in several important Key Performance Indicators:
| Key Performance Indicator | Stakeholders' Reported Results1 |
|---|---|
| % of denials due to missing attachments (Unsolicited Model) | 35% reduced to 5% |
| % of solicited requests due to missing attachments | 25% reduced to 5% |
| % of appeals due to missing attachments | 80% reduction |
| Payment revenue cycle | 35 days reduced to 16 days |
| Payer status follow-ups | 75% reduction |
| Onboarding provider timeframe (Variables: attachment model/EDI readiness) | 83% reduction from weeks to days (Leverage existing IT connectivity and workflow processes when adding a payer ID) |
| EDI adoption ratio | Processing over 2.7 million 275s |
The Veradigm Payerpath Medical Claim Attachment solution can streamline the management of medical claim attachments through every step of the process. By automating the medical claim attachment process, both payers and healthcare providers can save duplicated effort, cost, and frustration. Automation can also help decrease the time required to process medical claims, with the associated positive impact on patient outcomes.
Contact us today to learn more about how your organization can benefit from Veradigm’s electronic medical claim attachment solution.
References:
- Payerpath Medical Claim Attachment Solution. Veradigm; Accessed November 20, 2023.