Health insurance industry shows improved claims processing capabilities

Health Care Reform

Health Insurance Claims

Report targets the health insurance industry

The American Medical Association (AMA) has released its fifth annual National Health Insurer Report Card. The report aims to rank the country’s health insurance companies based on their ability to serve customers and provides ratings based on issues such as transparency and business practices. According to this year’s report, the health insurance industry has made radical improvements to its operations. The report details these improvements and how they may be affecting consumers and highlights an issue that has garnered a great deal of interest lately: Claims.

Insurers cutting down on incorrectly processed claims

According to the AMA, claims have been a point of concern for several years. The organization has long voiced its disdain for the shortfalls it has witnessed in the claims processing capabilities of many companies in the health insurance industry. The AMA notes that approximately 19% of all health insurance claims filed in 2011 were processed incorrectly. This resulted in higher administrative costs for insurance companies as well as additional stress of consumers. This year, the health insurance industry seems to have fared more favorably.

1 in 10 claims processed improperly, according to report

The report shows that nearly 1 in 10 – 9.5% — of all health insurance claims filed so far this year have been processed incorrectly. The AMA notes that the improvements that insurance companies seem to have made to their claims processing systems have saved the industry, as a whole, more than $8 billion. Many of the improperly processed claims have funneled funds to those that were not due benefits. The AMA estimates that this has produced approximately $7 billion in wasteful spending.

Industry continues to show signs of improvement during time of great change

The health insurance industry in the U.S. continues to undergo significant changes. These changes may be encouraging insurance companies to adopt more effective practices and processing procedures in an attempt to better serve consumers. The AMA considers the rise in insurance companies able to accurately pay out insurance claims to be a good sign.

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