BC Advantage - 2018 Issue 11

People Process and Technology Three Avenues for Better Claims Performance

Anecdotal evidence shows that up to 70% of claims submitted by a medical provider have either missing or incomplete information. These errors could be minor (think name mismatch), or more troublesome like missing Social Security or Medicare numbers that make adjudication impossible.Surprisingly, fewer than 30% of claims are returned for zero payment, according to the National Health Insurer Report Card. Most of the time, it’s because the patient is responsible for the balance against a deductible. Seven percent of claims are returned because of edits, and another 5% for some other type of denial. Even with a...

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