Streamline claim attachments

Simplify the claim attachment process to improve partner adoption.

Attachment Management

Currently, over 20-30% of all claims will require some type of supporting documentation from a provider or hospital system. And according to CAQH CORE, each claim could cost $6 or more to receive, review, prepare and send (using traditional methods like mail and fax). To reduce this administrative burden a strategy should include a multitude of communication channels and integrate systems/workflows.

Our Approach

Attachment Management introduces a new approach that enables secure exchange of electronic attachments, automates cross-enterprise workflows, drives provider adoption and cost-effectively integrates with existing payer back-end systems. Payers can tighten reimbursement processes and providers can comply at lower cost.

The solution consists of key components: Transaction Management Attachment Module – an add-on to the Smart Trading platform; Attachments Service Module – a provider-facing, all payer, cloud-based web service; and CollabLynk – enabling secure data exchange between all parties involved.

Capabilities

Enables sharing of claims attachments

Enables payers to electronically request, and providers to electronically respond to claims and member requests for information across a multitude of communication channels.

  • Complete end-to-end electronic exchange and management of medical documentation.
  • Securely connect to provider systems and desktops then intelligently route to existing payer back-end systems.
  • Support multiple communication channels and link provider responses to correct claim.
  • Uploaded attachment in any format and ensure transparency with track end-to-end tracking.

Drives easier adoption

The solution offers significant cost reduction for providers by offering multiple avenues to electronically receive and respond to payer attachment requests.

  • Simple setup and support for a virtual printer direct from the EHR systems.
  • "Safe harbor" 277/275 and emerging standards (FHIR).
  • Receive responses direct or through a payer portal.
  • Integrate an existing document management systems.

Supports cross-enterprise workflow integration

Both payers and providers gain total visibility and clarity of next steps in the end-to-end attachment lifecycle.

  • Provider self-service signup with payer approval.
  • Payers can generate attachment requests, monitor provider responses and spot problem areas to pro-actively take action.
  • Providers can track open requests with clear understanding of requested medical documents, task assignments and due dates and get insights into submission problems.
  • Support solicited and un-solicited modes with attachment receipt and email notify.

Deep payer integration

By leveraging a unique edge of enterprise position, the solution is able to collect medical documentation across all communication channels and intelligently route them to existing back-end systems.

  • Scale value-based care initiatives without disrupting internal processes.
  • Backend integration to payer systems and existing provider portals.
  • Support claim adjudication, risk adjustment, and quality metrics.
  • Support any document type to resolve issues related to claim denial appeals, prior authorization, pre-certification, quality reporting, and chart pulls for care management.