One-Fifth of Insurance Claims Are Processed Improperly, AMA Finds
Health insurers process nearly 20% of claims inaccurately, which contributes to about $17 billion annually in unnecessary administrative costs, according to the annual National Health Insurer Report Card released by the American Medical Association, Modern Healthcare reports (Zigmond, Modern Healthcare, 6/20).
To create the report card, AMA analyzed a random sample of 2.4 million electronic claims for about four million medical services submitted between February and March of this year.
According to the report card, commercial insurers had an average claims processing error rate of 19.3% this year, a 2% increase from last year (Goedert, Health Data Management, 6/20).
The report card also ranked health insurers on their claims processing accuracy rate. It notes that:
- UnitedHealth Group had the highest rating, with a 90.23% claims processing accuracy rate;
- Regence Group Blue Cross Blue Shield had an 88.41% accuracy rate; and
- Anthem Blue Cross Blue Shield had the lowest rating, withÂ a 61.05% accuracy rate.
In response to the report, Robert Zirkelbach -- a spokesperson for America's Health Insurance Plans -- said insurers and health care providers share the responsibility of ensuring accurate and efficient claims processes.
"Health plans are doing their part by collaborating with providers and investing in new technologies to improve the process for submitting claims electronically and receiving payments quickly," Zirkelbach said, adding, "At the same time, more work needs to be done to reduce the number of claims submitted to health plans that are duplicative, inaccurate or delayed" (Japsen, Chicago Tribune, 6/20).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.