Many payers require you to “attach” additional information (e.g., discharge summaries, operative reports, implant invoices, or detail bills) with a patient’s claim to support processing. Most organizations will hold these accounts from billing electronically and print the claim and additional information to send in the mail, causing an unnecessary delay in payments for those claims. In this post, we will talk through two methods to improve this claim attachment process and get your claims, and attachments, to the payer and the payment back sooner.
Before jumping right in and making changes to your existing processes, set up a meeting with your clearinghouse vendor and IT team to understand what functionality is available and/or currently contracted. Not all clearinghouses have the ability to send claim attachments themselves, so they use another clearinghouse to handle that portion of the process. Ensure that you have the process clearly documented for reconciliation and to reference if there are issues with the process in the future.
ANSI 275s
The ANSI 275 Patient Information format allows you to send the needed documentation to the payer to eliminate the need for faxing/mailing the documents, streamlining the process. Using the ANSI 275 format, you can communicate information about the patient, such as patient name, attachment control number (which links the attachment and claim together), and service information to the payer using loops and segments, similar to how you send claims. These ANSI 275 files are then transferred directly to the payer or submitted through a clearinghouse where they are matched to the corresponding 837 file.
Unfortunately, not all payers have the ability to accept and read these files, but more payers are adding the functionality. Using the ANSI 275 format accelerates the adjudication timeline, since your claim and attachment will now get to the payer the same day and not have to wait in the mail system. It also reduces your overall cost since you no longer need staff to manually print the documentation required and you no longer need to pay for the materials (e.g., paper, ink, envelopes, postage).
Streamlined Attachment Process for Electronic Claims
For payers that do not accept ANSI 275s but still require attachments, some clearinghouses can upload documents that they will send to the payers electronically. You can streamline the process in your Epic Hospital Billing Claims, Professional Billing Claims and Release of Information (ROI) modules to do the work for you so that you can still send electronic claims and include the attachment control number to indicate that there is an attachment associated with that claim. Using ROI reports that look to the information needed for the payer, the system can pull the right information during claims processing, save it to a file, and link it to that patient’s claim. With your attachments now saved to a file, the clearinghouse can receive the upload and send them electronically.
with the patient’s claim. While this is not as efficient as the ANSI 275 process, you still get the benefits of accelerating the adjudication timeline and reducing costs while getting great utilization out of your Epic system.
In the ideal world, your organization would be able to fully automate all of your claim attachments, either through the ANSI 275 or using a streamlined process through your clearinghouse. However, there will continue to be instances where this will not be achievable due to payor limitations, such as the payer not being able to accept electronic attachments or attachments over a certain size, or for attachments that require user review before sending to the payer. Despite this, your organization can dramatically increase efficiency and reduce costs by leveraging the Epic system functionality as much as possible.
How We Can Help
At The Wilshire Group, our experienced staff can work with you to understand your claim attachment workflows and help put a more efficient process in place – helping you get claims that require attachments to payers quicker, with less cost, and get the payments back in faster. Reach out today to chat with us about your claim attachment workflows.
