Rise in Electronic Claims Submission Speeds Up Receipt, Processing Time

Survey finds health plans processed 98 percent of claims within 30 days 

Washington, D.C.—Health insurance plans processed 93 percent of claims within 14 days of receipt, and 98 percent of all claims within 30 days, according to the latest survey released by America’s Health Insurance Plans.

The rise in electronic claims processing systems has expedited receipt and processing of claims submitted by health care providers. Notably, between 2002 and 2011, the percent of claims submitted and processed electronically nearly doubled from 44 percent in 2002 to 94 percent in 2011. Furthermore, health plans received 66 percent of claims within two weeks of the service date, up from 58 percent in 2009 and 45 percent in 2002.

Despite improvements in claim receipt times, a significant percentage of claims were received after 30 days. Notably, 16 percent of electronic claims and 54 percent of paper claims were received from health care providers more than 30 days after the service date.

“This survey demonstrates that health plans are playing a leadership role in improving claims processing,” said AHIP President and CEO Karen Ignagni. “Increasing the percentage of claims submitted and paid electronically will reduce paperwork, improve efficiency, and help bring down costs.”

Highlights of the survey include:

  • In 2011, 93 percent of electronic claims were processed within two weeks, compared to 79 percent of paper claims.
  • The percentage of claims that were automatically adjudicated—processed without manual intervention—rose significantly from 37 percent in 2002 to 79 percent in 2011.
  • In 2011, the average cost of processing a claim was reported at $1.36 per claim. The average cost of processing an automatically adjudicated claim was $0.99 per claim; the average cost of processing a “pended” or delayed claim (often a claim that requires additional information or more complex manual processing) was $3.99 per claim.
  • In 2012, responding plans estimated that 88 percent of all claims were paid on an “in-network” basis, up from 85 percent in 2008.

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