Electronic Claims Attachments: Supplemental Medical Documents

Electronic Claims AttachmentsElectronic Claims Attachments are supplemental documents providing additional medical information to the claims processor that cannot be accommodated within the claim format. Common attachments are Certificates of Medical Necessity (CMNs), discharge summaries and operative reports. They are sent to the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) and/or A/B MAC with the original claim or in response to a request from a DME MAC or A/B MAC.

According to estimates from payers, providers continue to file and submit insurance claims electronically. However, dental providers are still slow to adopt electronic claims processes. This is despite the opportunity for huge savings by eliminating costly manual transactions, according to the 2015 CAQH (Council for Affordable Quality Healthcare) Index. In fact, dental providers lag behind their medical industry counterparts by as much as 30 percentage points in adoption.

In the dental sector, the average paper attachment processed per claim costs is $10.81 versus an electronic claim attachment of 84 cents. Aan annual claims load averages 5,000 for a dental practice, where 50% of all claims require a supporting documentation for adjudication. Actual figures may vary, of course, but the costs still weigh heavily in favor of electronic versus paper-based attachment submission. When using electronic attachments, with a few simple keystrokes, practice administrators can simply capture or upload requested documents. A unique tracking number is then assigned to the claim and it is transmitted securely to the payer. Once the third party payer or health plan receives the claim, examiners then have the ability to easily view the supporting documentation. All this without a single piece of paper being used.

Practices that adopt electronic claims processes experience significant improvements in their revenue. Electronic claim attachment solutions require minimal time and training to implement with payers and practice management system vendors. On September 23, 2005 a Notice of Proposed Rule Making (NPRM) was published in the Federal Register announcing proposed standards for six types of electronic claims attachments and the standard to be used by health benefit plans to request an attachment and identify the type of information that is needed. A copy of the implementation guide proposed in that NPRM as the national standard for these attachments is available without cost at the Washington Publishing company web site.

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