Creating email protocols to handle complex claims submissions

Email provides a method of segmenting and organizing the claims submission process to allow handling the complexities that may arise. 

The problem with claims submissions

A study published in The Medical Legal Aspects of Acute Care Medicine, “Claims submission is the process of direct communication between the physician practice and an insurance company.”

Despite the routine nature of submission processes, complex claims arise from high-cost procedures with lengthy additional clinical procedures that need to be separately coded during charge capturing. In these cases, providers often have to maintain a higher degree of coordination leaving room for error. 

Errors then result in delays in the insurance claims process that cause a backup in billings. The burden then results in the need to confirm all source documentation and use the treating physician's time to confirm procedures undertaken. 

This is a prime example of hundreds of causes of the backup and eventual problem caused by the claims submission process.

The fundamentals of handling complex claims submissions 

• Accurate coding
• Complete documentation
• Understanding the payer's rules (insurance, Medicaid, etc)
• Use reliable billings and claims software
• Review before submissions
• Communicate effectively 

Creating email protocols to handle complex claims submissions 

Email protocols can mitigate the strain placed on organizations as a result of particularly complex cases. The fundamental concepts related to handling complex medical claims as well as the use of simple steps for staff to follow allow for the best possible outcomes. 

A general guideline for creating these protocols includes: 

• Create secure email standards: Makes use of HIPAA compliant email systems for proper data transmission. 
• Establish clear email policies: Develop specific policies around the use of email for claims related emails. The policies need to outline who can send and receive these emails, how to handle information, and procedures to attach documents. 
• Using automated data extraction tools: Employ automated tools to extract data from emails and directly input them into claims processing systems. 
• Provide dedicated email channels: Establish email channels or subaddresses specifically for claims related communications. 
• Strategic email segmentation: Train staff to segment email communications based on the type of claim. High value, urgent claims should be tagged and separated to avoid the more complex claims getting lost in routine communications.
• Quality assurance checks: Perform regular quality assurance checks on the email handling processes.

See also: Top HIPAA compliant email services

FAQs

What is subaddressing? 

It is a technique where the users add extra details to email addresses to filter and organize incoming emails.

What is BCC?

Blind carbon copy, is a feature in email that allows the sender to include recipients secretly.

What is charge capturing?

The process in healthcare where services provided to a patient are documented and recorded.