Today, 84 percent of “attachments” sharing medical information between providers and health plans are exchanged through mail or fax, resulting in administrative inefficiency and delays in patient care, according to a new white paper released by CAQH CORE. The white paper, “CAQH CORE Report on Attachments: A Bridge to a Fully Automated Future to Share Medical Documentation“ highlights challenges associated with the exchange of medical information and supplemental documentation used for healthcare administrative transactions.
The term “attachment” refers to patient-specific medical information or supplemental documentation used to support claim payment, prior authorizations, value-based payments and other administrative transactions. With more than 200 million attachments exchanged annually by providers and health plans for claims alone, a reliable, secure and uniform attachments workflow is essential for the U.S. healthcare system to function efficiently.
Impact of Inefficient and Manual Exchange of Attachments
One regional health plan participating in the CAQH CORE Attachments Environmental Scan indicated that it takes 792 labor hours, the equivalent of nearly 20 people working full-time, to process the attachments it receives by mail, fax and web portal in the course of just one week.
“The inefficient and manual exchange of attachments has real member consequences,” said Lou Ursini, Head IT Program Delivery for Aetna/CVS. “It delays prior authorizations, hinders the transition to value-based payments, and costs plans and providers time and money, along with significant member frustration. We believe this research represents real opportunities for the industry to drive electronic adoption of attachments through operating rules.”
5 Opportunity Areas to Improve Electronic Exchange of Medical Information
The CAQH CORE study identifies five opportunity areas to improve the exchange of attachments:
1. Workflows: Clear documentation requirements and operating rules will reduce the burdens associated with solicited and unsolicited attachments. The 2017 CAQH Index12 estimated that conducting a manual (mail or fax) claim attachment costs providers $1.68 each, electronic attachments cost an estimated $1.17 each. Health plans have an even greater cost savings opportunity with manual transactions at $1.74 each, a cost that falls to just 10 cents each when electronic methods are used.
2. Data Variability: Electronic data files and uniform datasets will make it easier for health plans to keep attachments linked to associated administrative transactions and enable automated adjudication processes.
More than two-thirds of attachments received by health plans are saved in an unstructured file format. Vendors also receive a high proportion of PDFs, but far fewer image files and DOCs and a slightly higher proportion of structured files. Inconsistency in file sizes has also created a problem for health plans, with some participants noting that storage capacity has become an issue. For example, one health plan participant representing an insurer with fully electronic capability indicated that limits have been implemented allowing its system to accept as many as six files totaling 35MB per transaction.
3. Exchange Mechanisms: Greater adoption of electronic methods will streamline the number of ways attachments are exchanged and reduce reliance on manual methods, such as mail and fax.
More recently, most of the health plans participating in the environmental scan indicated that they were piloting at least one electronic transaction to automate the request and submission of additional documentation between health plans and providers.
4. Connectivity, Security, and Infrastructure: Uniform communication standards in these areas will make it easier to connect, secure and share data between clinical and administrative systems.
As part of resolving foundational interoperability issues, an attachment solution must address when and why clinical and administrative systems should communicate, such as to acknowledge receipt of an attachment.
5. Resources: Transparent and uniform documentation requirements across the industry will enable the vendor community to develop applications that can interoperate with plans, clearinghouses, and other intermediaries to support providers.
Impact of Increasing Electronic Methods for Exchanging Attachments
Increasing the use of electronic methods for exchanging attachments could have far-reaching impacts on the nation’s healthcare system. For example, automation could reduce per-transaction costs for the exchange of attachments by over 60 percent. For providers, it would ease administrative burdens related to the collection, processing, scanning, and storage of documents received by mail. As the designated operating rule authoring entity for attachments by the Secretary of the Department of Health and Human Services, CAQH CORE intends to use the findings from this research to support future operating rule development.
“Given the volume of attachments that are exchanged between payers and providers every day, increasing automation could have a significant impact on the efficiency and effectiveness of our healthcare system,” said April Todd, CAQH Senior Vice President, CORE and Explorations. “