Managed Care


AMA applauds claim processing improvement

MANAGED CARE August 2012. © MediMedia USA
Compensation Monitor

AMA applauds claim processing improvement

Physicians are a tough audience for clinician executives at health insurance plans. We’ve been reporting on the doctor-plan tension for a long time, and have excitedly — but always warily — noted any sign of rapprochement. (For instance here, way back in 1998: Truce!)

One of the things that obstructed such cooperation was physicians’ feeling that plans weren’t paying them on time. Another was the belief that they were paying them less than they were due. That sort of thing will tick someone off. However, according to the 2012 National Insurer Report Card ( released by the American Medical Association, insurers have made progress in paying claims. This year, they paid the wrong amount 9.5 percent of the time; last year it was 19.3 percent.

Officials at America’s Health Insurance Plans say part of the reason for the better scores is that plans gave doctors more accurate data. “This survey data are more comprehensive and reflective of what is already happening in the marketplace,” says Robert Zirkelbach, spokesman for America’s Health Insurance Plans.

“Health plans are doing their part by collaborating with providers and investing in new technologies to improve the process for submitting claims electronically and receiving payments quickly. At the same time, more work needs to be done to reduce the number of claims submitted to health plans that are duplicates, inaccurate, or delayed.”

Meeting expectations

“On what percentage of claim lines does the payer’s allowed amount equal the physician practice’s expected allowed amount?”

More prior authorization

Percent of claims

Prior authorization

Source: 2012 National Health Insurer Report Card, American Medical Association


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