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AMA report card highlights inaccurate health insurer claims payments

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Unnecessary administrative costs from inaccurate health insurer claims payments added an estimated $1.5 billion to the US health care system, according to findings from the American Medical Association’s fourth annual National Health Insurer Report Card.

This increased financial burden was the result of an extra 3.6 million erroneous claims payments compared with last year.

The national claims-processing error rate increased 2% to 19.3% from last year. Eliminating claims processing errors could save the country $17 billion, according to AMA estimates.

UnitedHealthcare was the only commercial health insurer in this analysis that demonstrated improvement in accuracy of processing claims, with an accuracy rating of 90.23%. Anthem Blue Cross Blue Shield was at the bottom of the list, with an accuracy rating of 61.05%.

Other findings in the analysis indicated that physicians received no payment from commercial health insurers on nearly 23% of submitted claims. Aetna, Anthem Blue Cross Blue Shield, Health Care Service Corporation and UnitedHealthcare decreased denial rates. The lowest reported denial rate in the industry remained CIGNA, at 0.68%.

The current report card was the first to evaluate claims for information on whether physicians ask permission before performing a treatment or service. CIGNA had the highest rate of claims requiring prior authorization, according to the findings.

UnitedHealthcare demonstrated improvement in reporting the correct contract fees to physicians. Other insurers showed improvement in this area in previous years, but they had slight declines this year. Anthem Blue Cross Blue Shield has steadily declined in accurately reporting the correct contract fees to physicians during the 4 years of the report card.

CIGNA and Humana have halved their median claims response time from the first report card to the current one. The range of response times was a median of 6 to 15 days.

For more information, please visit www.ama-assn.org/go/pmc.

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