This message serves as an update on our ongoing efforts to minimize disruption caused by the cybersecurity event at Change Healthcare (CHC), with a specific focus on Electronic Remittance Advice (ERA) delivery (835 files). We appreciate your continued patience and understanding as we work to resolve these challenges. Please click here for more information on expediting enrollment with UHIN and FAQs regarding the CHC cybersecurity event.
Collaborative Efforts to Restore ERA Delivery:
UHIN is actively working to restore consistent ERA delivery for our broader provider community. Our internal teams, including enrollment specialists, application support staff, business analysts, and software engineers, are collaborating closely with their counterparts at our clearinghouse partners. This combined effort is focused on facilitating the smooth and efficient transmission of 835 files.
Acknowledging Provider Challenges:
We understand the difficulties this outage has caused for providers who rely on timely ERAs for accurate payment reconciliation. We are committed to making significant progress in opening these critical channels for a wider range of providers.
Positive Developments and Upcoming Information:
We have made significant strides in restoring ERA delivery functionality. We will provide more detailed information and a clearer timeline for full restoration once we complete the next round of testing currently underway.
Continued Commitment and Support:
UHIN remains dedicated to resolving outstanding issues and ensuring a smooth claims processing experience for all our customers. We will continue to provide regular updates and are here to assist you. Please do not hesitate to reach out to our customer support team if you have any questions or require further assistance.
For many of us, Memorial Day marks the unofficial start to summer. Hard to believe we’re heading into June! In this month’s newsletter, we look at the importance of resilient, redundant and interoperable systems, the events and webinars coming up, and we attempt to foretell everything that will happen for the rest of the year.
The first half of this year was packed with exciting news and rocked by tech incidents. While we can’t predict the future, we can plan a better path ahead.
Look into your crystal ball đź”® What are your predictions (big or small) for things to come in healthcare this year? And, what are your goals that you hope to accomplish? We want to hear from you!
Healthcare IT Today Podcast: Will the Change Healthcare Ransomware Attack Wake Up Healthcare?
John Lynn and Colin Hung look at where the industry stands just two months following the ransomware attack. For healthcare professionals, this could be a watershed moment for information security, revenue cycle management (RCM) and back-up planning for potential, future incidents.
Our most recent blog post (authored by Brian Chin, UHIN’s CEO) addresses the importance of redundant and resilient healthcare systems, and how they support seamless interoperability in times of crisis. There are, of course, great benefits and challenges when it comes to maintaining interoperability during disaster recovery (see them below👇).
September 13: Utah Medical Association (UMA) annual House of Delegates in Midvale, UT
October 15-17: Civitas Annual Conference in Detroit, MI
​​​​More to come: Stay tuned!
Trainings and Webinars
Upcoming Online Trainings & Webinars
We’ll host training sessions on the new CHIE platform, specifically for portal users. Stay tuned for more details on our virtual Payer Panels where you can ask questions and get answers from health plan representatives.
This month we announced our affiliation with Comagine Health and added new CHIE data sources from CommonSpirit Health. We look forward to growing with our new strategic partners, customers, and you! Keep reading for what else happened in April and what’s coming up next month.​​​​​​
P.S. Follow our LinkedIn page for more frequent news, posts and insights
Spotlight
UHIN and Comagine Health Announce Our Affiliation
“Aligning our health care knowledge and expertise through affiliation is a profound opportunity to advance our parallel missions, while delivering greater success to our customers and partners. We have collaborated successfully for more than a decade. As affiliates, UHIN and Comagine Health can serve as a unified force for change in health care for the foreseeable future.”
​​​​​​- Brian Chin, UHIN’s Chief Executive Officer
Keep scrolling for more information on our affiliation.
HIT News
The Full Release on our Affiliation
We have announced our official affiliation with Comagine Health, a national nonprofit healthcare consulting firm. We have a long history of working together over the last decade on federal and state initiatives to advance electronic health record (EHR) adoption, cost transparency reporting, capacity and functionality of all-payer claims databases (APCDs) and interoperability and surveillance activities. Combining our technology solutions and Comagine Health’s analytic services will enable more actionable health insights and more sustainable, transformational improvements for communities.​​​​​​
The CHIE adds CommonSpirit Health as a Data Source
The CHIE continues to add important data sources, providing healthcare professionals with vital medical information when it is needed most. Recently, we’ve onboarded CommonSpirit Health as a data source.
We’re attending the WEDI Spring Conference from May 13 – 16 (virtually). We look forward to learning more from experts, like Aneesh Chopra, about solutions to improve information exchange, enhance care quality, and reduce cost and burden.
In addition to online product trainings for our customers, we’re preparing virtual payer panels for later this year. These will be similar to the payer panels you may have attended in previous years at the HIT Conference.
Wrapping Up
Report: Significant Differences in Administrative Costs
We’re reading the recent CAQH report on the wide differences in administrative transaction costs for generalists, specialists and behavioral health providers. “The medical industry spends an astonishing $83 billion annually on staff time to conduct routine administrative transactions between providers and health plans during and after a patient-provider encounter. Providers shoulder 97 percent of these costs.”
The CHIE continues to add important data sources, providing healthcare professionals with vital medical information when it is needed most. Recently, we’ have’ve onboarded CommonSpirit Health as a data source.
These include:
Holy Cross Hospital – Davis (formerly known as Davis Hospital and Medical Center) in Layton
Holy Cross Hospital – Jordan Valley (formerly known as Jordan Valley Medical Center) in West Jordan
Holy Cross Hospital – Jordan Valley West (formerly known as Jordan Valley Medical Center-West Valley Campus) in West Valley City
Holy Cross Hospital – Mountain Point (formerly known as Mountain Point Medical Center) in Lehi
Holy Cross Hospital – Salt Lake (formerly known as Salt Lake Regional Medical Center) in Salt Lake City
And their clinics
CommonSpirit Health is a nonprofit, Catholic health system dedicated to advancing health for all people.
“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.
