Essentials:

NHXS Report on Denied Health Care Claims

National Healthcare Exchange ServicesThis 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

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