Improving Workers’ Compensation Claim Processing with Interoperability
Data — big data — permeates every aspect of our modern lives and workplaces. This is especially true for healthcare providers and those handling workers’ compensation claims. While the concept of data interoperability is not a new one for the healthcare or workers’ comp industries, much progress still needs to be made.
ARRA And HITECH
The ARRA — or American Recovery and Reinvestment Act of 2009 — was established to improve the U.S.’s infrastructure. One of its provisions, the HITECH Act — or Health Information Technology for Economic and Clinical Health Act — established the need for interoperable electronic health records (also called EHR) as a specific goal. Accomplishing this goal leads to improved, efficient patient care as well as improved revenue cycles for providers. The 2009 Act, in a nutshell, also offered financial incentives to providers for moving to electronic health records. Over time, the program has evolved to a focus on Promoting Interoperability.
Health Information Exchange, Or HIE
Another important concept when talking about interoperability is Health Information Exchange — often shortened to HIE. This is a growing practice among health care providers which aims to improve patient care as well as the efficiency of the provider through automation, communication, and accuracy.
Interoperability In The Real World
Looking at what we’ve established so far, everything sounds wonderful — but in the real world of payor to provider communication, it isn’t so easy or clear-cut.
First, many providers have simply not yet moved to digital records or digital communication. This is especially relevant to smaller practices and rural areas, but isn’t limited to them; many providers have their own unique reasons for not making the move. Some are concerned about not only the costs of moving to a digital system, but also the time and training involved. This happens despite the numerous benefits to be had in the long run, not to mention pressure from payors and other administrative parties.
Second, the standards required to navigate not only EHR systems but the communication between payors and providers — as well as ensuring patient privacy and security — are extremely complex. Systems often do not easily “talk” to each other, or they store back-end data in incompatible formats, for some examples.
Swiftivity Enhances Interoperability For Workers’ Compensation Claim Handling
Our portfolio of services at Swiftivity, including our workers’ comp clearinghouse services, are designed explicitly to address the challenges of interoperability, especially as it pertains to speeding up workers’ compensation claim processing. Our goal is to help improve patient care, lower costs, and create an efficient claim process for both payors and providers.
Our Prior Authorization software for workers’ compensation claims allows for expedited prior authorizations (RFAs) in a secure digital platform that is easy to manage, deploy, and track. In fact, all that is needed for payors to receive an authorization is a valid email address — and for providers, we’ve perfected the mapping process to speed up integration and avoid the confusion of navigating multiple digital standards. After the system is implemented. we support our clients with comprehensive training to make sure the transition is a seamless one.
Learn how Swiftivity can help you on your journey to interoperability with our prior authorization tool!
