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Helping Health Care Payers Improve Claim-Payment Accuracy

First few Article Sentences

The American Medical Associationís fourth annual National Health Insurer Report Card found that commercial health insurers average a 19.3 percent error rate in processing claims, up 2 percent from the previous year. This increase means there were 3.6 million more erroneous payments and $1.5 billion worth of additional, unnecessary administrative costs in the health care system. The AMA estimates that eliminating all errors would save more than $17 billion overall.

Since the previous report, all examined health insurers but one failed to improve their accuracy rating; United Health Care was the only commercial insurer to demonstrate an improvement. Claim-payment accuracy is a major concern for large commercial insurers, self-insured employers, independent physician associations (IPAs), and any organization that strives to accurately adjudicate health care claims. The big question, of course, is why these efficiency and accuracy levels are so troubling and potentially such a drag on the overall health care system.

Adams, Paul

Hodges, Deanna

Moss Adams LLP

Claim-Payment Accuracy

May 8, 2012

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