2018 Conference Highlights: Achieving Payment/Remittance Electronification in Healthcare

At our 2018 Healthcare and Check Payment Technology Conference in Nashville, TN, Robert Bowman, CORE Director at CAQH; Tim McPherson, VP of Strategic Alliance at OrboGraph; and Bryan Bruton, Technology Business Executive at OrboGraph, delivered a presentation exploring issues surrounding adoption of payment and remittance electrification in the healthcare space – – something we obviously take very seriously at the home of the OrboAccess suite of healthcare payment solutions.

Interesting data was presented during the section of the presentation exploring adoption rates of fully electronic transactions for medical plans. The steady climb across the board – – claim submissions, eligibility and benefit verification, clean status inquiries, etc. – – show variable progress toward full adoption.

2017 CAQH Index: Overall adoption of fully electronic transactions for medical plans (2018 CAQH, All Rights Reserved)

Further CAQH data showed significantly lower adoption of fully electronic transactions for dental plans.

The presentation proposed the following major challenges in providing end-to-end electronification and adoption in the industry:

  • Major industry priorities continue to affect providers
  • Awareness of enrollment improvements
  • Multiple payer enrollment cycles/process
  • Diminishing returns in implementing new payers for 835/EFT due to lower paper volume concentrations
  • Provider testing requirements of new EDI 835 test files
  • Internal commitment to 100% electronification of payments and remittances

Still, as evidenced by the chart above, full adoption may not be happening tomorrow, but it will happen soon enough to negatively impact organizations that fail to take those first steps in earnest. In the face of an increasingly “retail” healthcare environment, it will be impossible to compete without maximum revenue cycle efficiency!







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