Why Should Providers File Claims Electronically?

Nationwide, just over six percent of healthcare claims are submitted using paper forms. That number has remained steady over the past few years, even though research has shown conclusively that providers can save more than 50 percent on administrative costs by submitting claims electronically. In 2015, CAQH research showed that it costs a provider $1.36 to submit a paper claim, while submitting that claim electronically costs just 35 cents – a savings of almost 75 percent.

If you operate a small practice, are an atypical provider, or a specialist, you are more likely than hospitals or larger practices to submit paper claims. As a result, you have a lot to gain from electronic submission, even if some claims will still need to be submitted manually. Here are a few compelling reasons why you should file electronically whenever possible:

Faster Payment

When you file a paper claim, it can take five to seven weeks to receive payment, while filing electronically can reduce that timeframe to two weeks or fewer. If managing cash flow is an issue, receiving payments more quickly can help address this.

Faster Processing

Some payers offer real-time adjudication for routine claims, which means you can find out within seconds whether the claim will be accepted, instead of waiting days to find out whether the payer received the claim via the U.S. Postal Service. Handling the paper claim once it arrives also adds time to the process.

Greater Accuracy

Most electronic claims submission systems can pre-populate claim forms with your business information. Some systems offer pre-submission “scrubbing,” in which the claim is checked against a set of validation rules. Claims that pass validation get submitted, and those that don’t are returned for correction, helping you avoid a common reason for denial.

Submitting claims electronically also reduces mistakes that are caused when paper claims are converted to an electronic format. While conversion software is more accurate than it used to be, poorly photocopied claim forms and illegible handwriting can lead to mistakes, which causes claims to be pended or denied.

Reduced Denials

Most systems that handle claims also offer electronic verification of insurance eligibility, so you can eliminate one of the most common reasons for denial. The same systems can often track the claim’s status through to the electronic remittance advice. With electronic funds transfer, you receive payment from the payer much more quickly.

In addition to the reasons covered above, you should also consider automated claim submission if you are moving to value-based reimbursement models. To see how electronic information sharing affects traditional fee-for-service and value-based payment models for providers, download the free research report, Provider Outlook On Value-Based Payment Models.