A report card on health insurers' claims processing practices shows wide performance variations among seven national commercial payers. As a group, they also have considerable room for claims processing improvement, according to the American Medical Association's third annual National Health Insurer Report Card.
In total, 20 percent of physician claims are processed inaccurately, according to the AMA, which claims fixing that problem could save $15.5 billion annually. Two thirds of the studied insurers are below 90 percent in the percentage of claim lines where the payer's allowed amount equals the contracted fee schedule rate by major CPT code categories.
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