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.
there is really no comparison when you begin to look at the pros and cons of
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.
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.
Electronic Data Interchange (EDI) has a number of benefits over billing paper.
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
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.
submitted electronically are usually paid earlier than paper 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
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.
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
is a much safer, HIPAA compliant, way to submit claims.