According to AHIP, more claims are being received by payers in electronic formats, and payers are processing those claims at a faster rate than before.
ACCORDING TO America’s Health Insurance Plans(AHIP), more claims are being received by payers in electronic formats, and payers are processing those claims at a faster rate than before.
Ninety-four percent of claims were submitted electronically in 2011, up from 82% in 2009-a significant jump in a short amount of time. In spite of criticism that health plans do not pay promptly, AHIP research shows that plans process 98% of all claims within 30 days, and 99% of claims within 60 days.
Automated processing has also increased, although there’s still some room to improve through payer and provider efforts. In 2011, 79% of claims were adjudicated automatically, up from 75% in 2009. By comparison, in 2002, only 37% of claims were autoadjudicated.
Of course, it’s in a plan’s own best interest to adjudicate automatically and save on administrative costs. Data indicates that autoadjudication costs 99 cents per claim, while delayed claims that often require manual processing cost $3.99 apiece to reconcile.
More members are staying in-network as well, according to AHIP. In 2012, 88% of claims were paid on an in-network basis, up from 85% in 2008.
The increase in electronic systems among providers has helped fuel the improvement in claims receipt and processing times. Even so, as many as 17% of claims are still languishing with providers for more than a month after services are delivered. And as many as 9% of claims in 2011 were received more than 60 days after the service date, including 38% of all paper claims.
AHIP’s survey was based on aggregated data from more than 453 million claims.
Provider payment turnaround
On the provider side, practice-management company athenahealth routinely tracks how quickly payers turn around payment to providers. In its 2012 PayerView study of data for more than 33,000 providers, athenahealth found that major payers, including Humana, Aetna and UnitedHealthcare-the industry’s top performers-averaged 26.1 days to process payment through accounts receivable. Major payers also resolved claims payment on the first pass 95.5% of the time in 2011.
Medicare and Medicaid tend to pay more slowly and resolve less frequently on the first pass.
Overall denial rates ranged from a low of 3% for Medicare claims in both Georgia and Oregon (tied) to a high of 16% for Medicaid claims in Louisiana.
Some speculate that updated HIPAA standards and the ICD-10 coding changeover will cause a noticeable slowdown in receipt of claims, adjudication and days in accounts receivable. Providers’ attempts at meaningful use could further slow the process. MHE