AMA applauds claim processing improvement


Physicians are a tough audience for clinician executives at health insurance plans. We’ve been reporting on the doctor-plan tension for a long time, and have excitedly — but always warily — noted any sign of rapprochement. (For instance here, way back in 1998: Truce!)

One of the things that obstructed such cooperation was physicians’ feeling that plans weren’t paying them on time. Another was the belief that they were paying them less than they were due. That sort of thing will tick someone off. However, according to the 2012 National Insurer Report Card released by the American Medical Association, insurers have made progress in paying claims. This year, they paid the wrong amount 9.5 percent of the time; last year it was 19.3 percent.

Officials at America’s Health Insurance Plans say part of the reason for the better scores is that plans gave doctors more accurate data. “This survey data are more comprehensive and reflective of what is already happening in the marketplace,” says Robert Zirkelbach, spokesman for America’s Health Insurance Plans.

“Health plans are doing their part by collaborating with providers and investing in new technologies to improve the process for submitting claims electronically and receiving payments quickly. At the same time, more work needs to be done to reduce the number of claims submitted to health plans that are duplicates, inaccurate, or delayed.”

Meeting expectations

“On what percentage of claim lines does the payer’s allowed amount equal the physician practice’s expected allowed amount?”

More prior authorization

Percent of claims

Prior authorization

Source: 2012 National Health Insurer Report Card, American Medical Association

Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

Apply via email to jfedder1@hfhs.org or online at http://p.rfer.us/HENRYFORDlXqAJA

Subscribe to Our Newsletters

Monthly table of contents

Be notified as each issue of Managed Care is available online.

Biweekly newsletter

Recent topics have included:

PTCommunity news

New drug approvals, clinical trials, drug management. Three times per week.

UP NEXT

Managed Care
By Peter Wehrwein
Managed Care
By Howard Wolinsky