Change Healthcare has unveiled new technology that is intended to help providers anticipate payers’ requests for attachments to medical claims in order to justify payment.
Claims attachments—additional documentation verifying the services provided and justifying why they were performed—have historically resulted in non-automated approaches to the claims submission process that have short-circuited timely payment.
At the HFMA Annual Conference in Las Vegas, Change Healthcare said its Assurance Attach Assist module, part of its Assurance Reimbursement Management suite of solutions, can anticipate the documentation requirements of eight payers. By determining what supporting documentation is needed, providers can eliminate some of the typical back-and-forth communication that may prolong payment cycles, the company contends.
In addition to using edits to proactively identify claims that need additional documentation, the new module enables users to electronically submit attachments both during and after claims submissions.
The module works with several commercial, Medicaid and Medicare payers—these include Medicare (solicited attachments only), Medi-Cal, Blue Cross California Medi-Cal, Anthem Blue Cross–California, Anthem Blue Cross Blue Shield–Nevada, Anthem Blue Cross Blue Shield–Colorado, PacificSource Health Plans and Washington Medicaid (solicited attachments only). The company is planning to expand the list of payers over time.
"The key to reducing denials is to address requirements on the front end before they become problems on the back end," says Marcy Tatsch, senior vice president and general manager of reimbursement and analytics solutions at Change Healthcare. "There are so many factors that can trigger a denial. Providers need proactive technology that helps them anticipate and eliminate issues before they cause a denial."
Each year, payers make more than 2 million requests for additional medical documentation through the claims process, Change Healthcare reports, citing data from the Office of Financial Management from the Centers for Medicare and Medicaid Services. Providers spend an average of $5.25 and 30 minutes per claim manually dealing with these requests, and about 10 percent of claims are denied each year because of missing documentation.
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