FEATURE STORY Precertification Current benefits to implementing this electronic solution Electronic precertification methods allow for easy submission and tracking of medical precertification requests. Staff make fewer phone calls and spend less time printing and faxing paperwork. Not only is submission faster, but electronic precertification provides you and your clients with a record of the claim and the decision from the payor, thereby eliminating the need to print and store paperwork. Why using other electronic solutions are beneficial Electronic precertification is an important step in helping streamline electronic claim submission and serves as the key approach to avoiding claim denials. New operating rules are coming in the industry for this solution Under the Affordable Care Act (ACA), operating rules for the exchange Using EFT and ERA together can shorten the payment cycle. of precertification information are currently being written by CAQH CORE. These rules are targeted to be available in late 2014 or early 2015 and will be mandated for use by January 1, 2016. Electronic Claim Submission, Electronic Attachments, and Claims Status Inquiry Current benefits to implementing these electronic solutions Electronic claim submission and electronic attachments offer significant improvements for claim processing accuracy, paper reduction and mailing expenses, creating an electronic record of submission details, and allowing for fast access to check claim status. If an error occurs with a claim submission, notification of the problem is often fast, and a claim can be corrected and resubmitted electronically, eliminating additional postage costs and mailing time. Why it is beneficial to be tied to other electronic solutions Electronic claim submission tracks a claim from initial submission through various stages while it is processed, then permits associating the electronic payment with the submitted claim. Integration with your electronic medical record (EMR) system can assist in providing electronic attachments in support of claim or precertification submissions. New industry solutions Under the ACA, electronic attachments will become HIPAAsupported transactions. Operating rules for the exchange of claim submission and attachments are currently being written by CAQH CORE. These operating rules are also targeted to be available in late 2014 or early 2015 and mandated by January 1, 2016. Electronic Funds Transfer and Remittance Information Current benefits to implementing these electronic solutions Electronic funds transfer (EFT), also known as direct deposit, allows you and your clients to receive and reconcile payments faster. EFT offers a more secure way to receive payment and eliminates the manual work involved in opening envelopes, going to the bank to deposit paper checks, and the wait-time for checks to clear to complete reconciliation. With electronic remittance advice (ERA), remittance information may be automatically loaded into your accounts receivable system, which can reduce costs and posting errors, as well as save time. Using EFT and ERA together can shorten the payment cycle. Some payors also offer online remittance reports, which can eliminate the need to store and access copies of paper EOBs. Why it is beneficial to tie these to other electronic solutions ERA assists with filing coordination of benefits (COB) claims by populating the primary payment information into the secondary claim submission. Additionally, many accounts receivable systems will calculate the expected payment amount based on the patient’s benefits and contracted amounts. The system will then alert you if the actual payment does not match the expected payment. New advances in the industry for this solution Under the ACA, operating rules to streamline EFT and ERA enrollment and assist with reassociating the EFT with the ERA were implemented and mandated as of January 1, 2014. THE JOURNAL OF THE HEALTHCARE BILLING AND MANAGEMENT ASSOCIATION 23
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