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Life Health > Health Insurance > Life Insurance Strategies

Studies Rate Health Claim Processing Efficiency

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Doctors and health insurers are dueling over who is more to blame for payment delays.

Athenahealth Inc., Watertown, Mass., a company that provides medical billing services and other services for doctors, has generated a report that uses claim performance data for 7,000 of its customers to tell the physicians’ side of the story.

America’s Health Insurance Plans, Washington, has come out with a report of its own based on a survey of member insurers. That report emphasizes the role that problems with physicians’ bills plays in slowing down health insurance claim processing.

The reports have appeared as members of Congress are drafting a health information technology bill.

Athenahealth, which has drawn on a database containing “5 million charge lines” of data collected during the fourth quarter of 2005, says some payers pay much more quickly and easily than others.

The average number of days a claim is in accounts receivable is 38, according to Athenahealth.

But the bottom-ranked carrier denied claims twice as often as the bottom-ranked carrier, and one carrier was far more likely than the others to say it could not find a claim.

Athenahealth also found wide variations of efficiency at state Medicaid programs.

Indiana denies claims 4 times as often as Ohio, and the Medicaid program that is slowest at paying doctors, the Indiana program, takes an average of 171 days to pay doctors, according to Athenahealth.

AHIP says in its own report that member carriers now process 57% of clean claims within 7 days of receiving the claims, up from 46% in 2002.

Only 5% of clean claims now take longer than 21 days to process, AHIP says.

But AHIP notes that insurers continue to get 25% of claims on paper, and that providers are filing about 15% of the claims 60 days or more after providing the services itemized in the claims.

About 14% of claims are not clean, and processing claims that appear to be incorrect or incomplete takes an average of about 4 to 25 days longer than processing a clean claim, AHIP says.

Insurers can process 71% of electronic claims automatically, but they can process only about 44% of the paper claims automatically, AHIP says.


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