“Our life is March weather, savage and serene in one hour” (Ralph Waldo Emerson)
Such was life in the healthcare information technology sector this month. We collectively faced daunting cyber circumstances and peered into an optimistic future filled with the possibilities of A.I., resilient and redundant networks, and healthcare interoperability for all.
Spotlight
Our Response to the Change Cyber Incident
UHIN is dedicated to maintaining interoperability for all payers, providers and partners. When an event as large as the Change Healthcare cyber incident impacts our community, we know we need to serve as a bridge to stable ground. Read more about the actions we’re taking to support our community at this time.
We’re actively supporting Providers by expediting enrollment with Payers to get claims flowing again. Providers can leverage our solutions to create and send professional and institutional claims, submit via SFTP, file tool or online hand-entry, check claims status, manage denials and rejections, and search, view, and download payment information.
We can connect with health plans, so they may receive claims from providers through a direct connection to our clearinghouse. Empower your provider network by elevating your collaboration efforts, securely sharing information and data, and providing better affordable care for your members.
The alarming rise in cyber threats – namely ransomware – highlight the urgent need for enhanced cyber resiliency and robust security measures in healthcare. Read our recent blog post with five ways to reduce your risk and secure personal health information (PHI) from cyberattacks.
HIMSS shared their recap of the 2024 Global Health Conference & Exhibition (March 11-15 in Orlando). Cybersecurity, A.I.,and health equity and access to care delivery were big themes this year. What were you most excited to learn at HIMSS this year?
We’re preparing a series of online trainings for CHIE users this year. Explore our new platform and share feedback with our HIT experts. Stay tuned for updates on upcoming trainings.
Wrapping Up
Thriving in Complexity from the Comagine Health Blog
Comagine Health President and CEO Marc Bennett addresses how the organization has been managing competing tensions while building partnerships to serve as a prime contractor for the 13th Statement of Work in the Midwest CMS QIN-QIO Region 6.
Thanks for spending this extra day going around the sun with us. In February, we dove into the 2023 CAQH Index Report and prepared for the CHIE’s migration to a new platform.
One more thing: For our providers experiencing disruptions in their claims management due to the Change cyberattack, we’re here to help. Please contact us to fast track your enrollment with payers at customersuccess@uhin.org.
Spotlight
Black History Month and American Heart Month
In February we recognized Black History Month and American Heart Month. Here are just a couple ways to support and celebrate these causes throughout the entire year:
For health care professionals and clinicians, use the resources in the Center for Disease Control (CDC) heart toolkit to support their patients, especially women, by listening to their heart.
In Utah? Dive into Utah’s rich black history at the Utah Black History Museum! Find the mobile exhibit across Utah this year or consider donating.
HIT News
The CHIE is Moving to a New Platform!
The new platform empowers CHIE users to better understand patient populations, provide greater care, reduce waste while improving quality, and pinpoint at-risk patients to intervene before their next encounter.
After consulting with our community’s advisory committee, we will be migrating five years of data with the exception of opt out consents, immunizations, allergies, and colonoscopies for which a longer history will be migrated.
Technical implementation is currently underway and we anticipate user migrations will start in Q2 of 2024. We will keep all CHIE users informed of our progress via email.
We published two blog posts sharing our thoughts on the most recent CAQH Index released earlier this month. How did electronic transaction adoption and healthcare administration change in 2023 for both providers and payers? Keep reading to find out.
Our CEO, Brian Chin, recently attended ViVe 2024. Artificial Intelligence was a hot topic this year, as you may have expected. Check out a few photos from the conference here.
Are you going to HIMSS 2024? Let us know what you’re most excited to see while in Orlando next month at communications@uhin.org.
Trainings and Webinars
CHIE platform trainings
We have online trainings coming up for the new CHIE platform. Please sign up for CHIE updates and our Events notifications to add these to your calendar so you don’t miss a thing!
Wrapping Up
Share your story, plus looking ahead to March
Do you have something your peers in healthcare and tech just have to know about? An innovative interoperability solution or point of view? Please email us at communications@uhin.org and we’ll include links to our favorite community content each month.
Next month we’ll attend HIMSS 2024 and help to raise awareness of the risks and symptoms of diabetes on American Diabetes Alert Day (March 26).
Join our monthly newsletter and don’t miss anything!
The Council for Affordable Quality Healthcare (CAQH) released their annual index report earlier this month. Data from the 2023 CAQH index sheds light on electronic administrative transaction adoption rates, areas of waste and cost avoidance, and the impacts of medical staffing shortages. At UHIN, we’ve recognized similar, significant trends through our claims management, specifically in claims submission, claims status inquiry and electronic remittance advice (ERA).
Here are our points of view and takeaways from the 2023 report:
Staffing shortages are a major issue
Electronic adoption increased
Cost and Time spent increased
Collaboration & flexibility are critical
Transaction findings:
Claims submission
Claims status
Eligibility and Benefits
ERA
1. Staffing shortages are a major issue
The COVID-19 pandemic strained the healthcare system, which led to significant staffing shortages that continue to impact the industry, especially for providers. The impact of the pandemic is felt most intensely in the time to conduct administrative tasks:
Provider time to conduct transactions increased in 2023, on average, 14 percent which accounted for 77 percent of the increase in total medical spend.
For the second consecutive year, time to complete electronic transactions grew. While staffing issues and transaction volumes increased, providers required more time to commit administrative tasks.
Staffing issues were felt in the hiring process as less experienced staff were onboarded who ”required more time to understand processes and requirements.”
Our MYUHIN billing and claim management solution helps ease the onboarding burden. An intuitive platform like MYUHIN won’t require hours of training to get the job done. New staff can get started quicker and manage your revenue and cash flow better from the start. Tools like Templates and Drafts reduce the time to submit claims. Everything will just fall into place for you.
2. Adoption increased:
In the “new normal” – as CAQH defines this era – adoption of electronic administrative workflows continued to rise in 2023 on the heels of new processes put in place during the pandemic. Per CAQH: “Automated tasks provided flexibility to staff as work environments changed and adapted to a new normal.” These transactions saw the greatest electronic adoption rate:
Remittance advice increased from 83% to 88%
Eligibility and benefit verification increased from 90% to 94%
Electronic claim status inquiries increased from 72% to 74%
Claim submission increased from 97% to 98% (almost reaching full adoption)
We noticed a rise in electronic claims submission this year, as well. MYUHIN delivered its one millionth claim in tandem with the uptick in submission volume. We empower you to accelerate your claim submissions, check coverage and benefits of patients in real time, and facilitate status inquiries from payers. These are all critical components to your revenue and cash flow management.
3. Cost and Time spent increased:
Per CAQH: “Despite the increase in electronic transactions and decrease in manual ones, overall spending on administrative tasks grew due to persistent staffing challenges impacting the time to conduct tasks.”
Provider time to conduct transactions increased 14% (on average), the second year that the time to complete electronic transactions has grown.
The amount of time for a provider to submit a claim can take up to 20 minutes for a paper claim and up to 10 minutes for an electronic claim.
Spending on claim submissions rose 67 percent to $19 billion
Medical providers reported spending, on average, 24 minutes on manual claim status inquiry, costing approximately $12 per transaction – the highest time and cost among the transactions along with prior authorization.
For providers, you can save time by checking eligibility and submitting claims with MYUHIN. If you want to reduce costs (who doesn’t??), our value pricing makes your decision to switch billing solutions a snap.
“With the data and technologies available to us today, we have the power to transform the way we conduct the business of healthcare. However, as an industry, we must align around consistent processes that enable providers to minimize the time spent learning new workflows. This is particularly important given the current labor shortage.”
Erin Weber, Chief Policy and Research Officer at CAQH (via CAQH)
4. Collaboration and flexibility:
Looking ahead, the CAQH index report notes: “As staffing concerns are expected to continue, the industry needs to work together to identify solutions and best practices for time savings.” Claim submission data was particularly dysfunctional between providers and payers, driving an increase in claim denials in 2023. We all need to work together to address the challenges in the medical industry.
We believe in interoperability for all. Healthcare is complex and challenging. Healthcare silos are ingrained in the industry. Where fragmentation begins, quality of care decreases and costs rise. When UHIN looks at the fragmented nature of healthcare we know we need to act and be a force for change.
5. Let’s dig into the transaction analysis:
Claim submission:
$2.1 Billion in cost savings opportunity annually for electronic claim submission
5 minutes in time savings opportunity per transaction for electronic claim submission for providers
Claims status inquiry:
The number of claim status inquiries conducted increased by 19%
17 minutes in estimated time savings opportunity per transaction
Medical providers reported spending, on average, 24 minutes conducting a manual claim status inquiry, costing approximately $12 per transaction – the highest time and cost among the transactions along with prior authorization
$3.2 Billion in cost savings opportunity annually for the medical industry
Eligibility and benefits:
Adoption of the electronic eligibility and benefit verification transaction increased 4 percentage points for the medical industry, one of the largest increases
Eligibility and benefit verification represents the highest volume transaction for the medical industry, accounting for 54% of all medical administrative transactions
16 minutes in time savings opportunity annually for electronic eligibility and benefit verification for the medical industry
$9.3 Billion in cost savings opportunity annually
Electronic remittance advice:
Adoption increased to 88% (the highest increase among the transactions)
$701M in cost savings opportunity annually for electronic remittance advice for the medical industry
5 minutes in time savings opportunity annually for electronic remittance advice for the medical industry
The Council for Affordable Quality Healthcare (CAQH) released their annual index earlier this month. Data from the 2023 CAQH index report sheds light on electronic administrative transaction adoption rates, time savings, cost avoidance, and the need for collaboration. The effects of the COVID-19 pandemic continue to be felt across sectors, adding to the strain of increasing costs, decreasing cost savings opportunities and increasing time spent on administrative tasks. Yet, there’s still hope. At UHIN, we’ve recognized similarly significant trends in our Clearinghouse transactions and claims management, specifically in claims submission and electronic remittance advice (ERA), and offer solutions that can move health plans to a more positive outcome for themselves and their members.
Our most intriguing takeaways from the 2023 CAQH index report:
Volume increased
Cost avoidance opportunities persist
Collaboration & flexibility will be key moving forward
Certain transactions make a big impact:
Claims submission (ASC X12N 837: request to obtain payment or transmission of encounter information for the purpose of reporting delivery of healthcare services)
Remittance Advice (ASC X12N 835: an explanation from a health plan to a provider about a claim payment)
1. Volume increased
The index report highlights that electronic transaction volume increased, but for one notable exception, in 2023 (for both payers and providers).
Electronic claim submissions increased from 8,751 to 9,476
Claim status inquiry increased from 2,254 to 2,820
Only Electronic remittance advice decreased, moving from 2,499 last year to 2,080 in 2023, marking a 22% decrease
We facilitate each of these transactions and provide other valuable services, like EDI enrollment, to health plans. Since 1993, we’ve empowered our customers to provide better care and better costs to their members. To this day, we remain at the vanguard of electronic data interchange (EDI) and interoperability. Are you ready to learn more about our claims management solutions?
Overall, the estimated medical industry spend increased from $55 Billion to more than $82 Billion, driven primarily by staffing shortages coupled with volume increases. In tandem, cost savings opportunities decreased to $16.4 Billion. The report reveals that $89 billion, or 22% of National Healthcare Expenditures in the U.S., is spent on administrative transactions, with potential savings of $18.3 billion through fully electronic transactions. Health plans can still save more than $140 million annually by automating transactions:
Savings opportunities:
$104 million with electronic claims submissions
$38 million by moving to electronic remittance advice
It’s important to remember that you don’t need to sacrifice quality when decreasing costs. UHIN provides high quality electronic claims management services at a comparatively low cost. We’ve been doing this for health plans for more than three decades and remain dedicated to our mission: Better costs and better care.
3. Collaboration and flexibility are key:
Looking ahead, the CAQH index report notes that the “industry will need to collaborate and remain flexible in order to identify opportunities and best practices, and respond to emerging and consistent challenges and business needs.”
We couldn’t agree more. Healthcare is complex and challenging. When UHIN looks at the fragmented nature of healthcare we know we need to act and be a force for change. As a central, neutral, community-created organization, we bring together all players in the healthcare environment to create a more connected healthcare system.
“With the data and technologies available to us today, we have the power to transform the way we conduct the business of healthcare. However, as an industry, we must align around consistent processes that enable providers to minimize the time spent learning new workflows. This is particularly important given the current labor shortage.”
Erin Weber, Chief Policy and Research Officer at CAQH (via CAQH)
4. Let’s dig into the transaction analysis:
Claims submission:
$2.1 Billion in cost savings opportunity annually for electronic claims submission for providers and payers combined
While electronic spend on claims by plans decreased in 2023 (from $576 Million to $517 Million), the total of costs avoided increased (from $4.2 Billion to $5 Billion)
Electronic remittance advice:
Adoption increased five percentage points across the medical industry to 88% (the highest increase among the transactions)
Medical volume decreased 22 percent
$701 Million in cost savings opportunity annually for electronic remittance advice across the medical industry
Question 4: How Does Your EDI Partner Reduce the Burden of Claims Submission for Providers?
Plan members want access to a range of high- quality providers. Without a robust provider network, health plans are challenged to grow membership and differentiate themselves from competitors.
The Council for Affordable Quality Healthcare (CAQH) 2022 Index reported that providers spend ten minutes submitting a single electronic claim on average. For paper, it’s 22 minutes. A large part of this is repetitive data entry. These time blocks add up to significant resource drains in a typical day. Alleviating stressors will reduce payer-provider friction and promote cooperation in your common goal to improve health outcomes for members.
With the right EDI partner, you can streamline operations, reduce administrative burden, and improve your organization’s bottom line. Embracing new technologies and cooperative partnerships can help you gain a competitive advantage and, ultimately, provide better care to members.
Our fourth and final question leads you to ask yourself: “Is my EDI partner providing holistic support to my partner’s and my own organization’s operations?”
Ready to jump to all four questions? Want to see how your EDI partner stacks up? Download our white paper here.
How Does Your EDI Partner Reduce the Burden of Claims Submission for Providers?
Plan members want access to a range of high- quality providers. Without a robust provider network, health plans are challenged to grow membership and differentiate themselves from competitors.
The healthcare industry is becoming more consumer-driven and labor shortages continue to mount. Health plans need to be mindful of provider relationships and the administrative burdens your claims processing may be placing on them.
The Council for Affordable Quality Healthcare (CAQH) 2022 Index reported that providers spend ten minutes submitting a single electronic claim on average. For paper, it’s 22 minutes. A large part of this is repetitive data entry. These time blocks add up to significant resource drains in a typical day. Alleviating stressors will reduce payer-provider friction and promote cooperation in your common goal to improve health outcomes for members.
Your healthcare EDI partner should help you to help providers with an affordable billing tool. Our solution, MYUHIN, reduces repetitive data-entry, and solidifies coding and submissions data to satisfy your processing requirements. Providers can use MYUHIN to submit claims, check patient eligibility, and search, view, and download payment information from any computer, any where.
UHIN is a national EDI network built in 1993 by health plans. We partner with payers and providers across the US. Our approach to EDI and customer service is different. If you’re interest in learning more, please contact us today.
Question 3: Are Providers Frequently Contacting You With Questions About Their Claims?
Health plans constantly seek to optimize their high-performing provider networks which provide value to members and patients. To grow these important networks, payers should nurture their provider relationships through personal attention and cutting edge technology.
This is particularly important at a time of mounting staffing shortages and rhetoric of economic downturns. Additionally, medical claim volume increased by 28% in 2022 as vaccines became available, medical offices reopened and pandemic regulations softened. When you add this up, the need for administrative simplification becomes more obvious for health plans and providers.
Tracking down claims, managing denials and submitting myriad claims can burden staff, compound labor costs and decrease profitability. When your provider network is stressed then your ability to grow as a carrier is impacted. Your EDI partner should automate workflows and manage your trading partner network so your support staff can focus on more strategic priorities, rather than answering phone calls and emails all day long.
Our third question addresses this concern as you ask yourself, “how does my EDI partner stack up?”
Ready to jump to all four questions? Want to see how your EDI partner stacks up? Download our white paper here.
Are Providers Frequently Contacting You With Questions About Their Claims?
When resources are tied up managing claim inquiries, you’re likely underperforming your peers and weakening your organization.
An inability to provide visibility to track and troubleshoot claims in a timely fashion can create financial implications. The increased demand on staff can decrease productivity, which could further delay payments and lead to staff burnout and turnover. Payers must respond to providers within a regulated timeframe, and providers rely on prompt payment for cashflows and their own business growth. Further dissatisfaction amongst providers and members can upend the collaborative nature of interoperability and could drive providers and members away to different plans.
The volume of inquiries to track down claims can burden staff and compound labor costs through the need to hire additional people. The situation can foster negativity between providers and operators, reducing satisfaction for both groups. Your EDI partner should work with you to increase your ability to automate claims processing. Part of this is facilitating a simple, electronic process for providers to submit their transactions and understand the status along the way.
UHIN is a national EDI network built in 1993 by health plans. We partner with payers and providers across the US. Our approach to EDI and customer service is different. If you’re interest in learning more, please contact us today.
Provider enrollment is crucial for health plans to ensure that members have access to a full range of services. Credentialing verifies a clinician’s training and licensing. Enrollment establishes the technical connection between the provider and the plan. The processes can be complex and time-consuming, but partnering with dedicated enrollment experts – like UHIN – can help streamline the onboarding experience and accelerate success in a highly competitive marketplace.
Why Enrollment Matters
Health plans are constantly looking for better ways to serve the insured, from developing innovative wellness benefits to making it easier to access high-quality, affordable care in the community.
Provider network development is a huge component of this quest for continuous improvement. Contracting with the right mix of providers – and enough of them – ensures that members can get a full range of services within an acceptable time frame.
Building this ecosystem isn’t always easy, especially when it comes to the nuts and bolts of bringing clinicians on board. Provider credentialing and provider enrollment are equally critical, yet they can often cause confusion and problems on both sides of the plan-provider relationship.
In fact, providers not being registered/credentialed with a payer is the #1 reason for denials. The #2 reason for denials: the provider did not complete the payer-required process for enrollment.
Both steps – credentialing and enrollment – are crucial. However, even the fundamental differences between the two activities aren’t always clear, especially because they bump up against each other during onboarding. It’s important to understand what’s involved in each process, how they work, and why finding the right partner matters so much to health plans as they grow and mature.
What is Provider Credentialing?
Provider credentialing is the act of verifying that a clinician has the correct training and licensing to practice in their area of expertise. It’s similar to an extensive background check. The process starts after a provider submits a request to work with a practice, health system, or health plan. Collecting this extensive dataset can take up to three months or longer.
While UHIN does not currently support the credentialing process, certain industry applications are in place, including the CAQH credentialing application. Until the credentialing process is complete, a provider cannot finish the rest of the enrollment process with a health plan. This is especially important for 98 percent of providers in the US who participate in Medicare and Medicare Advantage. In addition, nearly every health plan, including Medicare, requires EDI enrollment in order to start getting reimbursed for services.
What is Provider Enrollment?
Once a provider is officially welcomed into the network, the majority of health plans will require them to complete Electronic Data Interchange (EDI) enrollment, which is the technical connection between the provider and the plan. EDI enrollment allows providers to submit electronic claims to the plan and receive remittance for their services.
Electronic claims submission is nearly universal in the medical industry, according to the latest CAQH index report. In 2022, 97 percent of claims submissions transactions occurred electronically, giving both providers and health plans a strong motivation to ensure they are appropriately connected.
Unfortunately, neither the administrative nor the EDI enrollment processes are standardized across different health plans. This forces providers to juggle many different requirements and documentation requests for each individual payer. The complexity of managing requests from a slew of disparate plans and providers can lead to mistakes and omissions that extend the timeline.
Even more information may be required during EDI enrollment than credentialing. This can take an additional four to six weeks (or longer) on top of the credentialing timeframe. This is especially true if extensive contract negotiations are necessary or IT challenges get in the way.
In addition, smaller provider groups often do not have enough people-power to devote exclusively to enrollment, making it even more difficult for plans and providers to work together effectively.
UHIN’s Enrollment Team provides detailed next steps for enrollment based on each specific payer and transaction type for each case. Additionally, we provide defined next steps to move forward with enrollment, based on the payer requirements. UHIN can be reached at enrollment@uhin.org and we will be happy to provide enrollment direction, advice and helpful support through the EDI enrollment process.
How Can Health Plans Streamline Enrollment Processes?
Just like many other areas of the healthcare ecosystem, provider EDI enrollment can significantly benefit from digitization and strong partnerships with expert teams. The widespread lack of standardized processes means plans and providers have to consider each request as a one-off, which can take a great deal of time and effort to parse through without some help.
Charting a Course for Success
When working with providers, health plans should offer clear and detailed instructions on the information needed and the deadlines for delivering it.
Plans should assess their needs by charting out their existing enrollment workflow and identifying any bottlenecks that lead to lag time. Often, these pain points are related to delays in collecting information from providers and internal delays in processing paperwork once received. The result of these delays are wild swings in average completion time for provider onboarding, which creates unpredictability on both sides of the relationship.
Finding the Right Support
On the internal front, plans should seek out enrollment partners that can field provider requests on behalf of the payer, taking the task off the shoulders of health plan staff. It should take a specialist enrollment team less than one business day to process a request once all of the information is received. There may be additional waiting time depending on the unique payer requirements.
Health plans and providers should make sure they are working with a dedicated enrollment team that can take deep dives into problem-solving when unique technical or administrative challenges arise, such as a technology enhancement that can lead to the need for a process rewrite.
An experienced partner, such as UHIN, offers an expert enrollment team to help navigate the complicated enrollment process. Although we do not currently provide credentialing support, we have a proven history in expediting and accurately guiding providers through the enrollment process. Our enrollment team is based in the US and delivers in-depth knowledge and support to make the enrollment process as frictionless as possible. We can handle any questions you may have in this complicated and critical process.
Partnering with the Right EDI Enrollment Experts
Enrollment involves complex activities with many moving pieces. Getting them right is vital for the success of health plans and provider groups. By understanding the nuances of the process, plans and providers can start to tackle the pinch points that make network development so challenging. Plans that enlist the help of dedicated partners to take on key tasks, such as enrollment, have a better chance of creating a smoother onboarding experience and accelerating their success in a highly competitive marketplace.
UHIN’s enrollment team offers years of experience helping providers through the enrollment process. We provide direct support and in-depth knowledge to expedite the enrollment process and get providers over the finish line no matter how complex or unique the process may be.
Are you a current provider with a UHIN account and interested in learning more about enrollment? Contact enrollment@uhin.org or customer service at 877-693-3071.
If you’re new to UHIN, click below and tell us how we can help streamline EDI enrollment onboarding and relieve burdens for your health plan!
