Claims Management Automation Opportunities
Claims Management Automation and Remaining Opportunities
Providers and payers are increasingly adopting electronic claims management transactions, but remittance advice and prior authorizations are still largely manual.
January 22, 2019 – Electronic claims management adoption by plans and providers is at or above 80 percent for three of the seven transactions analyzed in the most recent CAQH Index.
The CAQH 2018 Index showed adoption of fully electronic eligibility and benefit verification increased six percentage points in the past year and reached 85 percent of transactions in 2018. Meanwhile, full electronic adoption of claim submission and coordination of benefit transactions reached 96 percent and 80 percent, respectively.
However, the healthcare industry still has room to improve their adoption of fully electronic administrative transactions.
To promote the development of claims management and administrative standards and operating rules, CAQH advised vendors to adopt standards.
“There is an opportunity for vendor systems to support the adoption of electronic transactions through more timely and comprehensive deployment of new and updated standards and operating rules,” the organization recommended in the report.
“In particular, gaps exist in vendor support for prior authorization, attachments and the dental industry generally. But the vendor community can accelerate the adoption and support the ongoing use of electronic transactions by prioritizing the development of solutions to address the gaps and cost savings opportunities identified in this report.”
Learn about EMS’s line of edi transaction tools for your organization…