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AMA: Insurers processing claims faster, more accurately


Insurers have been processing claims faster and with more accuracy and better explanation. They're also denying fewer claims to boot, according to the American Medical Association's annual health insurer report card.

The AMA reached that conclusion based on a random sample of about 2.6 million electronic claims submitted between February and March to eight of the largest insurers--Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corp., Humana, Regence, UnitedHealthcare and Medicare.

Among the findings within the report card:

  • Error rates fell from nearly 20 percent in 2010 to 7 percent in 2013. UnitedHealth was accurate 97 percent of the time, while Regence only had an 85 percent accuracy rate.
  • Medical claim denials decreased 47 percent from 3.48 percent in 2012 to 1.82 percent in 2013. Cigna had the lowest denial rate at .54 percent, and Medicare had the highest denial rate at 4.92 percent.
  • Response times improved by 17 percent from 2008 to 2013. Humana provided the fastest response time of six days, while Aetna was slowest at about 14 days.
  • Transparency of rules that insurers use to edit claims improved by 37 percent from 2008 to 2013.

But despite these improvements, the AMA said insurer's flawed claims systems still lead to payment disagreement and related issues that cost about $12 billion, Forbes reported.

"We can save the healthcare system a lot of money, which we could then spend on quality health care," AMA board member Barbara McAneny told the Cleveland Plain Dealer. "Unfortunately right now doctors can spend up to 14 percent of the amount that they're paid on collecting that money."

The AMA also ranked insurers based on the amount of unnecessary cost they add to the claims payment process, finding that the eight insurers analyzed contribute an average of $2.36 to each claim in unnecessary administrative tasks, avoidable errors, inefficiency and waste. HCSC had the highest waste cost per claim at $3.32, while Cigna had the lowest at $1.25.

To learn more:
- here's the AMA report card
- read the Cleveland Plain Dealer article
- check out the Forbes article

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