Transmission & Error Report ? How are they Important?

Posted by Deepak Sanghi on July 31st, 2015

Payment posting is a crucial process in medical claims processing, which has to be done in a well-timed manner. If the payments are not posted on time, then the billing system would reflect an artificially inflated AR. Likewise, transmission and error reports should be handled prudently to ensure proper claim denial management. Many healthcare entities fail to understand their importance and end up with an AR pile-up. With EDI set-up in place, most healthcare entities submit their claims through electronic means. Once these claims are submitted in batches, the first place they go to is the Clearing house and not the Payer. Without understanding what happens at this phase, many think that the claims have reached the Payer. The following information will shed light on what actually happens to the claims once they are submitted:

Clearing house Transmission and Error Reports: Before getting the actual claim denials from the Payer, healthcare entities get transmission and error reports from the Clearing house, initially. After performing a basic scrubbing process, the Clearing house will check for basic formatting errors and send an acknowledgement of acceptance or rejection to the respective healthcare entity. It is during this phase that the medical claims processing specialists should be more cautious. No worries if they get an acceptance report.However, if they get an error report, then the errors must be corrected and re-transmitted without delay. The claim’s ‘first-pass ratio’ will determine how many claims passed through the Clearing house.

Payer Transmission and Error Reports: After passing through the Clearing house, the claims undergo a second, advance level scrubbing by the Payer. Transmission errors and other entry level errors are found during this phase. The Payer will send an acknowledgement of acceptance or rejection to the respective healthcare entity. Again, the medical claims processing specialists should prudently act and correct these errors to re-submit. It is only after this phase that the actual claims processing happens resulting either in reimbursements or claim denials.

Reality Check: As a matter of fact, many healthcare entities overlook these transmission and error reports coming from the Clearing house and Payers. One of the reasons may be that they focus more on the medical billing AR follow-up and denial management, which is only the aftermath of claim denials. But in reality, if the transmission and error reports are handled wisely, there would be very less claim denials.

Solution: Yet another reason that healthcare entities overlook these important reports is that they do not have the resources and expertise to perform the task. Get help from a highly experienced offshore medical billing company like e-care. From doing the initial EDI set-up to handling transmission and error reports, e-care can handle things meticulously.

About e-care India:

e-care India has 15 years of experience in the industry.e-care’s 3 offshore medical billing delivery centers have been providing end-to-end medical claims processing services seamlessly to its clients. To know more about e-care and its services, log on to www.ecareindia.com.