NHXS Report on Denied Health Care Claims
Submitted by Tom McGuire on October 7, 2009 – 3:04 am | 435 viewsNo Comment
This email about the percentage of rejected claims from health insurance companies found its way into my inbox yesterday and I felt it revealed some interesting data related to the hot-button topic of government run healthcare. I’m not going to comment either way about this now but wanted to add it to the Tom archives for later retrospection.
Metric 12 – Percentages of claim lines (i.e., records) denied
Description: What percentage of records submitted are denied by the payer for reasons other than a claim edit? A denial is defined as: allowed amount equal to the billed charge and the payment equals $0.
Source: National Healthcare Exchange Services (NHXS)
| Payer | Count of records | Denied Records | Percent ofclaim lines denied | Date Range |
| Aetna | 637,293 | 43,317 | 6.8% | 03/01/2007 – 03/10/2008 |
| Anthem | 250,070 | 11,546 | 4.62% | 03/01/2007 – 03/10/2008 |
| CIGNA | 263,728 | 9,060 | 3.44% | 03/01/2007 – 03/10/2008 |
| Coventry | 20,487 | 590 | 2.88% | 03/01/2007 – 03/10/2008 |
| Health Net | 4,975 | 193 | 3.88% | 03/01/2007 – 03/10/2008 |
| Humana | 143,026 | 4,142 | 2.90% | 03/01/2007 – 03/10/2008 |
| Medicare | 6,938,431 | 475,566 | 6.85% | 03/01/2007 – 03/10/2008 |
| UHC | 1,127,691 | 30,177 | 2.68% | 03/01/2007 – 03/10/2008 |
