More doctors file electronically, industry says

The result is that claims are being paid more quickly, health plans say.

By Tyler Chin, AMNews staff. June 26, 2006.

The percentage of claims that private payers receive electronically from physicians and hospitals surged from 44% to 75% in the last four years, according to a survey released by America's Health Insurance Plans.

The survey, which is based on a sample of nearly 25 million claims processed by 26 health plans of varying sizes during a one-week period after Oct. 1, 2005, found that 98% of all electronic and paper claims are processed within 30 days of being received by payers, meaning that those claims are either paid or denied, said Larry Akey, a spokesman for AHIP. The industry group's survey did not say how many claims are denied.

About 14% of claims are "pended" or returned to clinicians because of incorrect or incomplete information, Akey said, noting "pended" claims become "clean" when the required information is submitted to the plans. Those claims, which on average take an additional nine days to process, are among the majority of claims processed within 30 days, Akey said.

AHIP also found that 30% of claims are received by payers more than 30 days after the date of patient service and 15% after more than 60 days, with one-third of paper claims received after 60 days.

The survey results, which exclude Medicare and Medicaid claims, show "that many people have moved away from paper and toward electronic claims submission and that by working together [with doctors and hospitals], we can perhaps improve the electronic submission rate even more," Akey said. That will further "speed up payment to practitioners and reduce administrative overhead throughout the system," he said.