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If you think you’re seeing more claims processing errors – you’re right
e-Reports, July 11, 2011
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Commercial health insurers have an average claims processing error rate of 19.3 percent, an increase of two percent compared to last year, according to the AMA’s fourth annual National Health Insurer Report Card. Find the full report here.

And if you think your practice could be seeing even more errors than nearly 20 percent – you’re likely right about that too. Anthem, a leading insurer in Indiana, scored the worst of all insurers measured with an accuracy rating of 61.05 percent.

Total cost to our health care system of all the errors? The AMA estimates that eliminating health insurer claim payment errors would save $17 billion.

“Health insurers must put more effort into paying claims correctly the first time to save precious health care dollars and reduce unnecessary administrative tasks that take time and resources away from patient care,” said AMA Board Member Barbara L. McAneny, M.D.

Most of the health insurers measured failed to improve their accuracy rating since last year. UnitedHealthcare was the only commercial health insurer to demonstrate an improvement this year in claims-processing accuracy. UnitedHealthcare came out on top of seven leading commercial health insurers with an accuracy rating of 90.23 percent.

Here are some other key findings:

  • Physicians received no payment at all on nearly 23 percent of claims submitted to commercial health insurers.
  • Anthem scored 14 percent lower than four years ago on how accurately it reported the correct contract fees to physicians. UnitedHealthcare showed consistent improvement; others progressive improvement.
  • Response time varied for the insurers from six to 15 median days.

Read a press release about the report card here.

Want to be part of the solution to improve claims processing efficiencies?

The AMA's "Heal the Claims Process"™ campaign has a goal of reducing the cost of submitting claims for physician practices from as much as 14 percent of revenue to just 1 percent – so you can worry less about administrative tasks.

Learn more on the AMA website.

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