The Impact of Electronic Administrative Transactions In A Crisis
Electronic administrative transaction adoption escalated significantly during the pandemic, largely to support remote administrative processes.
Source: Getty Images
- A crisis or public health emergency has the potential to impact every part of the healthcare system, including administrative transactions and workflows.
The coronavirus pandemic made clear the fact that no segment of the healthcare industry is impervious to the effects of a healthcare crisis, including the administrative processes that sustain the industry.
Administrative transactions span from the moment that a patient sets up a visit with her provider through prior authorization and even claims attachments. During a healthcare crisis, providers and payers may face a number of challenges in tackling basic administrative transactions, explained April Todd, senior vice president of CORE and explorations at CAQH.
Listen to the full podcast to hear more details. And don’t forget to subscribe on iTunes, Spotify, or Google Podcasts.
For example, when the coronavirus pandemic struck, a lot of typical services moved to telehealth, a channel for care that did not often undergo eligibility checks.
“Another challenge that often occurs with new things or crises is: how do you code for them in the claims process?” Todd shared in a Healthcare Strategies episode. “Oftentimes some of the coding needs to be manual for a while until the systems can catch up, to be able to adjust to it.”
CAQH reviewed the volume and utilization of administrative transactions during 2020 to see how the pandemic impacted these levels and released the report in late January 2022.
The organization saw adoption of electronic transactions jump 2.3 percentage points. The influx of electronic transactions was particularly noticeable in eligibility and benefit verification, prior authorizations, claim payments, and remittance advice.
“There was a lot of very quick adaptation because people were not in the office and they were not able to process those types of things,” Todd shared. “So across the board, we saw a silver lining with the pandemic, as we saw some improvement in automation.”
Although adoption of electronic administrative transactions and automation received a boost, volume of transactions did not necessarily replicate this trend. Instead, the coronavirus pandemic sparked an 11 percent decline in electronic medical administrative transactions as payers cut back on certain administrative requirements in order to lessen providers’ administrative burdens.
To Todd, the results of the report make a case for why payers and providers should consider transitioning to electronic administrative transaction processes in preparation for future crises.
“People underestimate the savings that you can get from automation,” Todd explained.
“What we've noticed through this survey is that the more that providers and plans automate, the more they see a volume boost in terms of cost reduction. They see bigger economies of scale than what they would have anticipated. And so, that is an additional encouragement, hopefully, for plans and providers to automate more.”
