Healthcare, RightFax & Medical Claims: From the Dark Ages of 1997 to Today

Capturing and processing insurance claims has become an enormously profitable cottage industry with new players emerging from behind every corner touting the latest innovations.

Today, most EHR systems support claim status tracking, error reporting, and claim reconciliation. But, let’s harken back to the days of Windows, Outlook 97 and Exchange Server 5.0 to catch a glimpse into the humble beginnings of claims submission and receipt just to see how far we’ve come.

Here’s a story for you. In 1997, United HealthCare (UHC) in Hartford CT approached us to leverage their RightFax platform (v5.0, by the way) to communicate with their vast provider community about claims. It was standard – due to efficiency and HIPAA regs -- to send confidential PHI claim information via fax.

So, the question came up, “Wouldn’t it be cool if we could provide and automate response to the providers with a confirmation receipt including a thumbnail of number of pages received?”

Yes, cool indeed. Also, not that difficult to develop.

Over a relatively short period of time and requisite UAT testing, the RightFax auto reply feature was born. It was simple in functionality, capturing the receiving fax CSID and/or ANI and sending back confirmation of receipt with the number of pages (and claims) received to providers. UHC was happy to have this enhanced efficiency and the providers were thrilled because they had better control and got paid much quicker. The overall effectiveness was at acceptable levels of around 75%.

Fast forward to 2020 and the perks of this simple feature have expanded in scope and complexity. No longer just a tool for healthcare insurance companies, it has taken hold and thrived in finance and legal verticals in particular.

Bit by Bit’s custom 3b DocRouter Auto Reply FaxBack dovetails nicely into this feature. Now in its 5^th or 6^th iteration, it too is constantly changing and evolving with enhancements based on client feedback. Today our Auto Reply FaxBack function will do all the requisite things it did 23 years ago, but includes many of the following features and components:

• Ability for business users to add, delete and modify auto acknowledgements and make real time changes via a user-friendly portal
• Set up custom routing rules based on sender fax number
• Generate audit trails of any addition, deletion or modification on each auto acknowledgement
• Permission for admin rights so not all RightFax users can modify add or delete
• Allow the creation of unique username and password admin log ons
• Different fax back acknowledgments for both failed and successful faxes
• Unique messaging provided on auto acknowledgement reply
• Inserts confidentiality notice on footer of back of fax

With functionality that includes input of fax numbers, caller ID, and receiving fax numbers, our solution contributes to an 85-90% success rate.

So, for today, let the massive claim processing players such as EPIC, HealthVue, and Athena battle for market share in solving the complexities of today’s claims management.

We will continue to provide simple and effective fax back and auto reply functionality via our custom 3b DocRouter Auto Reply FaxBack solution.