Helping Health Plans Reduce Claims Adjudication Cost
Healthcare claims adjudication is a complex and detail oriented process. The manual handling of paper claims not only increases the complexity of processing but also adds significantly to the cost of adjudicating claims. Fortunately, Imagenet provides solutions to this problem in the form of Imagenet's Paper to EDI Services. In this article, we will explore the top reasons why paper claims exist in the healthcare industry and why they aren’t going away any time soon, as well as the benefits of Imagenet's Paper to EDI Services in reducing claims adjudication costs for health plans.
Why Do Paper Claims Exist in Healthcare?
There are several reasons why paper claims still exist in the healthcare industry, despite the widespread adoption of electronic claims processing. Despite the widespread use of electronic health records (EHRs) and other technology solutions, paper claims still account for a significant percentage of all claims processed in the healthcare industry. Some of the top reasons include:
Lack of Access to Technology: Not all healthcare providers have access to electronic claims processing systems, and some may not have the resources to invest in them.
Lack of EHR adoption: In many cases, healthcare providers have not yet adopted EHR systems or have not fully integrated them into their practices. This can make it difficult for them to submit electronic claims, which can lead to the continued use of paper claims.
Inability to Transmit Electronic Data: In some cases, healthcare providers may not have the necessary technology to transmit electronic data, such as a secure internet connection or a compatible system.
Provider Preference: Some healthcare providers may prefer to continue using paper claims due to habit, familiarity, or lack of confidence in electronic claims processing.
Administrative Burden: The administrative burden of converting to electronic claims processing can be significant, especially for small healthcare providers.
Cost: The cost of implementing electronic claims processing systems can be prohibitively high for some healthcare providers, especially small and rural practices.
Top Drivers of Paper Claim Submission
Despite the benefits of electronic claims processing, paper claims are likely to persist in the healthcare industry for some time to come. Here are the top 25 reasons:
Coordination of Benefits
Medical Record Attachments
Corrected Claims
Non-contracted providers
Claims for services rendered out of state
Claims with specially negotiated fee schedules or procedure codes
Non-contracted ambulatory claims
Timely filing justification(s)
Medical Necessity Justifications
Claims seeking Retro Authorization
Member reimbursement requests
Lack of centralized systems
Specialty pharmacy / unlisted drug codes
Claims from providers that prefer not to use clearinghouses
High dollar claims with in patient stay information attached
Appeals & Provider Dispute Resolution (PDR)
Department of Financial Responsibility (DOFR) Claims
Claims sent via certified mail
Misdirected claims routing
Claims sent to uncontracted clearinghouses
Over /under payments
Returned checks
Faxed claims & Medical Records
Member and provider correspondence
Claims related to member eligibility issues
Imagenet's Paper to EDI Services: The Solution
Imagenet's Paper to EDI Services offer a solution to the ongoing problem of paper claims in the healthcare industry. This service converts paper claims into electronic data interchange (EDI) format, enabling health plans to efficiently process claims and reduce the cost of adjudication.
The benefits of Imagenet's Paper to EDI Services include:
Increased Efficiency: The conversion of paper claims into EDI format streamlines the claims processing process and reduces the risk of errors.
Cost Savings: By reducing the manual handling of paper claims, Imagenet's Paper to EDI Services can significantly reduce the cost of claims adjudication for health plans.
Improved Data Accuracy: The automatic conversion of paper claims into EDI format eliminates the risk of manual errors and improves data accuracy.
Increased Provider Satisfaction: By providing a simple and efficient solution for converting paper claims into EDI format, Imagenet's Paper to EDI Services can improve provider satisfaction and reduce the administrative burden of claims adjudication.
Reduced processing times: Electronic claims processing is typically faster than paper-based claims processing, which can help to reduce the time required to adjudicate claims and speed up the payment process.
Imagenet's Paper to EDI Services offer a solution that can help health plans reduce the costs associated with claims adjudication, while ensuring the accuracy and efficiency of claims processing. Although paper claims will likely never be completely eliminated from the healthcare industry, Imagenet's Paper to EDI Services provide a way to reduce their impact and help health plans to save time, money, and resources.