© Anastasiia Sarafanova | Dreamstime.com

Debunking the top misconceptions about electronic claims

Nov. 19, 2020
Are you one of the few dental practices still producing paper claims and mailing them to payers? Is it because of the negative things you've heard about electronic claims? Steve Roberts wants to set the record straight and explains the benefits.

There are tremendous benefits in moving to electronic claims submission, and yet a staggering number of practices still produce paper claims and mail them to payers. Why?

Many practices have preconceived ideas about why electronic claims technology won’t work for their businesses. Some worry about the security aspect of technology, some are concerned it will cost too much, and others think electronic claims technology will take too long to implement.

While it can be challenging to make a shift in daily operations, consider that electronic claims are not a new concept. In fact, they have been around for years and have seen significant adoption among practices. In 2015, approximately 74% of all claims used the HIPAA standard electronic dental claim format.

If your practice is still printing and mailing dental claims to payers, and spending hours tracking down status updates, additional documentation, and payments, there is an easier, more cost-effective way. Let’s debunk some of the common misconceptions around moving to electronic claims, and let’s get your practice moving toward substantial benefits for the future.

Misconception 1: It costs too much.

One of the easiest ways for dental practices to save money in the claims process is to switch from paper-based claims to electronic claims. There are solutions available for a low, flat monthly rate that include unlimited claims submissions.

The CAQH Index from 2019 promotes that electronic transactions and workflows are less expensive than non-electronic methods of sending claims. The average cost per transaction, inclusive of the labor time required, for a paper dental claim is $4.78 versus $1.47 for an electronic claim. If the average practice processes 5,000 claims a year, you could be looking at a total cost of about $23,900 if you were to submit claims manually. By submitting claims electronically, the same volume of claims would cost about $7,350.

Misconception 2: Not all of my claims can be submitted electronically.

All dental claims may be submitted electronically. This misunderstanding may be related to claim attachments and the notion you must print and mail those in separately to support the claim. However, with the right technology to support electronic attachments, that’s not an issue.

Misconception 3: I will still have to submit attachments via mail.

In a 2018 study, dentists said that on average, between 10%–50% of claims require some type of supporting documentation or claim attachment in order to be adjudicated by insurance payers. Many practices have resorted to sending attachments within standard email, which is not secure.

Electronic claims technology allows you to understand attachment requirements before submitting a claim, reducing the factor of a missing attachment as a reason for a rejected claim. The key is to implement an electronic claims solution that has integrated electronic claims attachment technology. What’s more, as of October 16, 2003, HIPAA mandates that all payers be able to accept electronic attachments.

Misconception 4: Payers don’t support electronic claims.

The CAQH Index reports 80% electronic claim adoption among payers in 2019, up 10% from 2015. If you encounter a payer that will not accept electronic claims, you can still submit electronically by partnering with a full-service clearinghouse. The clearinghouse can provide print and mail services for these types of situations.

Electronic claims are advantageous to both payers and providers as they are faster, more accurate, and less expensive to process. When you send a paper claim to a payer, the payer either internally or outsources the claim for paper to EDI conversion. The paper claim is scanned and indexed and imported into the payer’s claim adjudication system for review, adding time to the review process.

Misconception 5: The learning curve is too great.

Moving your claims submission process to electronic data exchange will cause minimal business disruption. Many electronic claims technology solutions are extremely user-friendly and require only brief training to get set up.

Think of it this way—investing a little bit of time now will save your office insurmountable hours in the future, hours that were previously spent printing and mailing claims and calling payers to check on claim statuses, additional requirements, and payments.

Misconception 6: Electronic claims are not secure.

You may perceive using paper claims as you having more control over what happens with the claim, and thus, you feel it’s more secure. However, electronic claims submission decreases your practice’s overall risk by providing technology safeguards such as passwords, message encryption, and date/time stamped records about who has accessed the data.

Using paper and standard mail to submit claims opens you up to human error, lost or unreceived communications, additional paperwork, issues with faulty or lagging mail service, and a potential data breach.

Now more than ever, practices are focused on streamlining operations and bringing in revenue. Moving to electronic claims can help you quickly solve these two major challenges. With minimal training, a low monthly fee, and additional safeguards, the benefits of electronic claims technology should be clear.

Steve Roberts is the president of Vyne Dental.