IVANS Survey Reports Medical Providers Look to One Solution to Process Claims

October 2, 2003

More than 60 percent of providers reportedly process commercial claims via the mail, according to a survey conducted by IVANS, Inc., a data networking provider to the health insurance industry.

Almost three-quarters of providers surveyed also reported that the HIPAA mandates for security and privacy have impacted the way they handle claims.

“There is a tremendous opportunity for healthcare payers to streamline claims submissions for providers via electronic solutions,” stated Maggie O’Hara, divisional vice president, IVANS Networking. “Payers that migrate from paper to electronic claims submissions via the secure networks that many providers are using today to process Medicare claims, or that invest in secure VPNs for web-based transactions, create efficiencies through the entire system.”

On average, a single medical provider such as a doctor, hospital, or nursing home facility – reportedly processes claims with up to 26 different payers, according to IVANS 2003 Provider Survey. While results show that the majority of payers with whom a provider processes claims are in the Commercial segment, the highest volume of claims processing is reportedly in the Medicare segment (55 percent), followed by Medicaid (27 percent), and then Commercial (16 percent).

“With the October 16 HIPAA compliance date approaching, we expect that many payers and providers will be re-examining the way they work with providers,” claimed O’Hara. “In fact, more than 35 percent of the providers surveyed indicated that the HIPAA mandates across the board – security, privacy, and transaction sets/codes – were having a big impact on the way claims are handled today.”

The findings reportedly showed that providers are processing claims transactions differently depending on whether they are Medicare or Commercial claims.

Forty-eight percent of providers surveyed process Medicare claims electronically via Batch mode using File Transfer Protocol, followed by Direct Data Entry (25 percent). Yet, in terms of Commercial claims, more than 60 percent are still being submitted on paper via the mail.

According to the survey, the provider community has the capability to process claims electronically. The majority of providers surveyed indicated that they have some form of Internet connectivity – only 9 percent polled say they have no connectivity.

Providers indicated that the inability to process claims electronically with all payers is one of the biggest challenges they face today when it comes to claims transactions.

A full 89 percent of respondents said that a single method for submitting claims with all payers was important to them, with only 10 percent of respondents indicating this was “not important” or “not important at all.”

The report is based on findings from a mail survey conducted by IVANS among 423 healthcare providers, ranging in size from large hospital facilities to small physician practices. The survey was conducted via mail from May 30-June 30, 2003.

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