Examining the Push Toward Real-Time Eligibility

Posted by Brinna Hanson on February 10th, 2023
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Brinna Hanson
Brinna is a marketing professional and graduate of the University of Minnesota. Brinna joined Smart Data Solutions in 2019 to assist the marketing department reach new heights with a focus on the HubSpot inbound process. From her time at Smart Data as well as at previous internships, Brinna has been able to gain knowledge in many different aspects of marketing as a whole.

At our 2022 Customer Symposium, we explored clearinghouse trends we’ve seen over the last few years. One of these trends has been the push toward real-time transactions, such as eligibility and benefits verification. People want information, and they want it fast — a trend accelerated by the pandemic increasing the volume of telehealth visits.

Moving toward real-time transactions requires advanced technology that’s oftentimes out of the expertise for healthcare facilities and hospitals. Because of this, partnering with a healthcare clearinghouse can expedite workflow upgrades by equipping organizations with automated processes, without needing to be responsible for ongoing management.

Behind the Data: Electronic Adoption of Real-Time Eligibility and Benefits

The digital world is built on speed. The success of consumer products, whether hardware or software, is determined by how fast teams can execute. The healthcare world is no different, and the push toward real-time transactions in this industry is a tangible example of this trend. 

When looking at real-time eligibility and benefit verification, the transactions at hand are CAQH CORE 270/271 and the HIPAA Transaction Standard: ASC X12N 270/271.

The CAQH Index reported that electronic adoption increased for benefit eligibility and verification in 2021. Despite lower healthcare utilization during the pandemic, which resulted in a decrease in the overall volume of eligibility and benefit verification transactions, medical spending actually increased. This is because eligibility and benefits verification is a major expenditure in the healthcare industry, accounting for almost half ($18.3 billion) of the total annual medical spend nationally ($37.4 billion).

The development of real-time eligibility verification presents a significant opportunity for cost savings going forward, pushing upwards of 45 percent to $9.8 billion. This potential reduction in administrative processing expenses has made real-time transactions a focus area for healthcare institutions looking to reduce their budgets.

Likewise, manual processing has become more complex and expensive, which conversely means that electronic processing has become more achievable and cost-effective. The below chart shows the two highest cost savings opportunities are eligibility and benefit verification and claim status inquiry.

Smart Data Solutions noticed the move toward real-time eligibility based on the services our customers were asking for. The No Surprises Act (NSA) could be driving this momentum because it increasingly moves the healthcare industry toward transparency with billing. Also supporting this trend, research by the CAQH Index reported significant savings when Providers focus on eligibility and benefits for electronic adoption. 

Based on all of these influences, we can conclude that real-time transactions are on the rise, and partnering with a healthcare clearinghouse helps ease the transition to automation that improves workflow efficiency and increases cash flow for Providers. 

Benefits of Electronic Adoption with Real-Time Eligibility

United Healthcare lists several benefits of electronic eligibility verification. These include increased productivity and efficiency because of less time spent on manual administrative tasks, and improved cash flow because of expedited reimbursement. 

Examining the Push Toward Real-Time Eligibility 1

These benefits only scratch the surface of adding automation to administrative workflows. Learn more about the advantages of working with a healthcare clearinghouse for automated administrative processing in our article, “Claims Management Services: Why Your Company Needs Them.“

Automate Real-Time Eligibility with a Healthcare Clearinghouse

Smart Data Solutions provides in-house automation and technology services to help companies move toward electronic processes. By focusing on real-time transactions with eligibility and benefits verification, we can lift and shift systems from manual to electronic. This can result in not only significant cost savings for Providers, but also improved efficiency, better human capital allocation, fewer errors, and an overall more cohesive workflow. 

The push toward real-time transactions in healthcare shows no signs of slowing down. The pandemic accelerated the adoption of electronic processes in healthcare, and created a growing demand for real-time eligibility and claim status information.

Transition your systems to work with a healthcare clearinghouse, optimize your workflows to receive real-time eligibility information, and prepare for the future of healthcare data, by reaching out to Smart Data Solutions today. Our in-house technologists will guide you through how we partner with healthcare organizations and transform their workflows to dominate the ever-changing digital landscape.

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