A new whitepaper from CAQH CORE, a multi-stakeholder healthcare organization, has identified five areas to improve the exchange of medical information and additional documentation used for healthcare administrative transactions.
The researchers for this study found that 84 percent of “attachments” that share medical information between providers and health plans are exchanged through mail or fax, resulting in administrative inefficiency and delays in patient care. So CAQH CORE—a group comprised of 130 participants representing providers, health plans, government agencies and standards organizations—set out to study how processes can be improved to accelerate the adoption of electronic attachments.
The term “attachment,” according to CAQH CORE, 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,” officials said in a press release announcing the study.
But more than eight in 10 attachments are currently being sent manually, and a majority of them are received by health plans with too much, too little or the wrong type of information. 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.
As such, CAQH CORE outlined five opportunity areas to improve the exchange of attachments:
- Workflows: Clear documentation requirements and operating rules will reduce the burdens associated with solicited and unsolicited attachments, CAQH CORE officials stated.
- 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, they noted.
- 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, the researchers believe.
- 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, they attested.
- 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, , CAQH CORE officials said.
“The inefficient and manual exchange of attachments has real member consequences,” Lou Ursini, head IT program delivery for Aetna/CVS, said in a statement. “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.”
Increasing the use of electronic methods for exchanging attachments could have sweeping impacts on the healthcare system, the researchers believe. For example, they noted that automation could reduce per-transaction costs for the exchange of attachments by over 60 percent.
And for providers, it would ease administrative burdens related to 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 (HHS), CAQH CORE intends to use the findings from this research to support future operating rule development,” its officials stated.
“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,” added April Todd, CAQH senior vice president, CORE and Explorations.
