Health Insurers Improve Claims Processing

From the article:

The percentage of claims incorrectly processed by health plans fell for the third straight year to 7.1% in 2013, according to the American Medical Association (AMA).

The error rate of commercial health plans in the National Health Insurer Report Card has dropped significantly since the 2011; that year, the report found that more than 19% of all medical claims were incorrectly processed. Last year, the AMA found about 9.5% of claims were incorrectly processed.

Is this the same industry – thru their contracted PBM’s… expects a 100% accuracy .. ZERO CLERICAL BILLING ERRORS… in pharmacy’s billing practices?

I guess the old saying applies here… ” don’t do as I do.. do as I say …”

Just imagine TWO YEARS AGO… their error rate was 19%+

One Response

  1. This is so ironic, just the other day my employer (an independent pharmacy that does compounding and retail ) got a letter from a PBM (xxx/xxxxmark) that stated we were being dropped for a minimum of two years. The reason they stated was because of audit discrepancies. The last audit was in our favor due to a math error on their part. How have we as a profession let a manager of paperwork to dictate medical care and who can provide that care. Seems similar to letting the bank tell me how to spend my paycheck.

    Maybe the discrepancies were that they were not able to recoup any money from you.. and they wasted money on doing the audit 🙁

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