Friday, May 21, 2010

Why clean claims are best ?

Proportion of “Clean” Claims

The vast majority of claims received, whether electronically or on paper, are “clean” and do not present problems with missing information or format errors. Claims received electronically have some advantage over paper claims across all provider categories surveyed. On average about 94 percent of claims received electronically are clean versus 86 percent of paper claims. Physicians
do slightly better on their percentage of clean claims than do hospitals (97 percent versus 94 percent for electronic claims and 89 percent versus 87 percent for paper), and both do better than other health care providers.

Automatic Adjudication of Claims

Electronically submitted claims have a large advantage over paper in the automatic adjudication of claims (claims processed without human involvement once they are entered into the processing system). There is almost a two-to-one margin in the percentage of electronic versus paper claims that are so adjudicated (49 percent versus 27 percent respectively). Automatic adjudication of claims allows for quicker processing times and less costly processing than manual intervention resulting in savings to the
health plan, providers, and ultimately consumers.

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