Electronic Claims Attachments Still a Rarity in the Healthcare Industry

Posted by Smart Data Solutions on December 18th, 2019
Smart Data Solutions

Electronic claims attachments, or eAttachments, are additional documents that go along with a medical claim that does not fit into the constraints of the claim itself. The attachments provide supplemental information the claims processor will use in processing the claim. These may include operative and discharge summary forms associated with the procedure claim, a Certificate of Medical Necessity, etc. There has been no federal mandate put in place, as of yet, but it is said that by December of this year there may be federal standards put in place that would require electronic claims attachment standards across the board. As of right now, a lot of these processes remain manual, which can be expensive, timely, and cumbersome to both payers and providers. 

We sat down with Chris Mueller, Clearinghouse Business Development Director at Smart Data, to ask him some questions about eAttachments in healthcare. 

Pat: How many attachments do health plans receive annually, monthly, or just in general?

Chris: According to CAQH there are about 200 million attachments going through, and of those 200 million attachments being processed, 80% are sent either by mail or fax to the insurance providers. So, it’s a very manual process across the industry. 

Pat: What does that workflow look like? 

Chris: Most of the workflow right now does include having attachments done electronically, mostly within the worker’s comp arena. Those are still somewhat of a manual process to where the bills and the claims get sent on to the insurance carrier. Then they have to marry up those bills and notes on the back end so a lot of times they are doing that separately. With the attachments, what you want to do is get it down to more of an automated fashion, where that information is being centralized in a system that is being viewed by those individuals that need that information. 

Pat: When you look federally, is there a federal attachment standard that is either changing or is out and it’s working — what does that look like?

Chris: It’s been going back and forth for a few years now, but according to the CMS, by December 2019 there is going to be a mandate that will standardize electronic attachments. Once that occurs, hopefully there will be more adoption (of eAttachments) within the industry. 

Pat: What are the benefits of an electronic attachment? 

Chris: Mainly it’s an administrative benefit, mostly on the payer side, and essentially comes to a cost factor. According to CAQH, it costs a payer about $1.70 to $2.00 to file a claim that has an attachment. If they do it electronically, they say it only costs about $0.10 to $0.15 per claim. So again, it is a huge administrative benefit on the payer side. On the provider side, it’s a benefit because it helps their revenue cycle when they can get paid faster. 

Pat: What is going on with electronic attachments today?

Chris: A lot of times I go to these conferences and they say that dental and worker’s comp is using eAttachments, which is correct, but on the dental side the claims aren’t going along with the attachments when they reach the payer. It is more of a portal-based situation, where the claim gets sent out and the attachment gets uploaded into the portal, where the payer would have to go view it within the portal. 

Pat: How can SDS turn attachments, right now, into useable information? 

Chris: We are currently working with some programs where we can use our AI and machine learning capabilities to take the images we get from the providers, and turn that unstructured data into a structured, usable form that the payer could utilize. 

Pat How can we assist with implementing those solutions today? 

Chris: Since we are doing attachments electronically today with worker’s comp, and with us being both a clearinghouse and data capture facility, it sets us up to be an efficient engine to handle eAttachments. So we have the infrastructure, we have everything we need, we just need the payers to go along with our program, which is like an autobot solution. 

We want to thank Chris Mueller for talking about the struggles the industry is having with implementing structure around eAttachments, and what we at SDS can do to help. We strive to automate workflows that improve how payers and providers connect during claims processing. Nothing can hurt the process more than a halt due to a manual process. With continued improvements in AI and machine learning, along with a potential federal mandate, electronic claims attachments could be well on its way to being common practice. 

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