Electronic vs Paper

When I started in this industry, years ago, we used a typewriter to complete claim forms and every claim was submitted on paper. Today, paper submission of claims is becoming a thing of the past with providers submitting most claims electronically.

We still have some situations where EDI falls short, especially in situations when we do not have the option to upload data to accompany the claim. For Example, claims for secondary or tertiary billing where an EOB is required to determine the plan’s liability, claims where additional information is required to support medical necessity like letters, test results and operative reports, claims where an invoice is needed for claim pricing.

However, there is really no comparison when you begin to look at the pros and cons of each.

Paper Claims

  • Paper claims are slow and cumbersome and can be hard to complete. The data has to fit squarely in the field, the ink can’t be too light to prevent front end scanning, some fonts are hard to read and some claims cannot be folded, requiring the use of large, more costly, envelopes and postage.  
  • Until the claim is scanned by the health carrier into their system, which could take days to complete, you have NO idea if the claim even reached its destination. Lost claims are a normal part of the paper claim submission process. There is nothing as frustrating as waiting weeks for a claim to be processed only to be told they do not have record of ever receiving the claim. The claim must then be rebilled and the waiting game must be started all over again.
  •  The claim is created and mailed to the health carrier and for some reason it is misdirected or lost and your Protected Health Information (PHI) ends up in the hands of someone who really does not need to know where you live, your phone number or what you are being treated for.

EDI

Clearly, Electronic Data Interchange (EDI) has a number of benefits over billing paper.

  • EDI claims are delivered much faster than paper; in a matter of hours instead of the days that it takes for the claim to reach the insurance carrier by mail.
  • NO lost or misdirected claims. EDI provides an automated date stamp that shows when the claim was received. This is critical when trying to dispute timely filing denials.
  • Claims submitted electronically are usually paid earlier than paper claims.
  • Claims submitted electronically are sent to a clearinghouse where they are subject to some edit and error detection processes that are designed to make you fix any problems with the claim before it goes to be processed.
  • Claims submitted electronically have lower overall costs. EDI eliminates the need for postage; bulk orders of CMS 1500 claims forms, envelopes, printer paper and ink cartridges.
  • Claims submitted electronically can also have claim payments and an EOB/Remittance Advice submitted electronically as well. This means faster secondary billing, posting of payments, patient invoices and account reconciliation.
  • EDI is a much safer, HIPAA compliant, way to submit claims.


Back to Chapter Five

Next to What You Need From Patient