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More Insurance Claims Filed Electronically

MedpageToday

Healthcare providers continue to file more insurance claims electronically and submit claims more quickly, a report from the leading health insurance industry group showed.

In 2011, 94% of claims were submitted electronically, up from 82% in 2009, according to .

The number of electronic claims today are even more staggering when you look at decade-long trends. In 2002, just 44% of claims were submitted electronically and 75% were in 2006.

"With the rise of electronic claims systems, healthcare providers are submitting a greater share of claims within 2 weeks of the service date," stated the report, which was released Wednesday.

In 2011, 66% of claims were received by health plans within 2 weeks, up from 58% in 2009 and 45% in 2002.

Despite the improvement in receipt times, the report notes 16% of electronic claims and 54% of paper claims were submitted more than a month after a service was provided. And 9% of claims were received more than 60 days after service -- down from 12% in 2009.

Faster claims filing translates into faster reimbursement for providers. The rise in electronic claims is credited by AHIP for speeding up the processing times for claims overall.

"Increasing the percentage of claims submitted and paid electronically will reduce paperwork, improve efficiency, and help bring down costs," AHIP President and Chief Executive .

Other key findings from the AHIP report:

  • Health insurance plans processed 98% of claims -- electronic or paper -- within 30 days, and processed 99% within 60 days of receipt. Processing time is defined as the number of days from when a claim is received until it is paid, denied, or held awaiting more information, the group said.
  • Roughly 79% of all claims were adjudicated automatically -- or without manual intervention -- in 2011, up from 75% in 2009 and 68% in 2006.
  • Auto-adjudication was used for 80% for electronic claims in 2011, compared with 53% for paper claims in the same year.
  • A total of 88% of claims were paid on an in-network basis, up from 85% in 2008.

It was the first time the AHIP collected data on claims paid in-network, it said. A recent report from the group highlighted out-of-network charges that were several times more -- often thousands of dollars more -- than Medicare pays for the same service in the same area.

The average cost to process a claim in 2011 was $1.36 -- $0.99 for automatically adjudicated claims and $3.99 for those not processed on the first pass. AHIP said that, overall, 4.6% of claims were processed more than once, with 0.8% including penalties or interest due to late payment.