Insurers process a tenth of claims inaccurately

Although insurers inaccurately process about one in 10 medical claims, they have drastically improved their claims processing accuracy since last year, according to a report from the American Medical Association (AMA).

The seven largest insurers--Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corp., Humana, Medicare, Regence and UnitedHealthcare--paid providers the incorrect amount for services rendered or incorrectly processed 9.5 percent of medical claims thus far in 2012, compared with 19.3 percent in 2011, the Chicago Tribune reported.

By improving their claims processing, insurers helped save $8 million in unnecessary administrative work. However, the AMA said the 9.5 percent claims errors rate still contributes to about $7 billion in wasteful spending, MedPage Today reported.

Measuring timeliness, transparency and accuracy of claims processing, the AMA's annual health insurer report card found that UnitedHealth had the best accuracy rating at 98 percent, followed by Aetna at 95 percent and Cigna at 90 percent. Humana had the lowest rating among the plans at 87 percent. For response times, Health Care Service Corp. had the fastest at six days while Aetna had the slowest at 14 days, Forbes reported.

America's Health Insurance Plans (AHIP) said insurers have been streamlining administration and improving efficiency but also placed responsibility on doctors and providers to help improve the claims process.

"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," AHIP spokesperson Robert Zirkelbach said. "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."

To learn more:
- read the Chicago Tribune article
- see the Forbes article
- check out the MedPage Today article

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