Benefit Accuracy Rate

Benchmarking Report

Benefit Accuracy Rate

This PDF report includes benchmarking data (in a visual, chart-based format), an comprehensive KPI definition, characteristics of high performers and technical details on measuring Benefit Accuracy Rate. Purchase and download this easy-to-understand, presentation-ready report immediately to compare performance levels, set attainable performance targets, and push towards best-in-class performance for this KPI.


What is Benefit Accuracy Rate?

The number of patient responsibilities for health insurance claims in which the payer returned the correct patient responsibility information (based on patient benefits eligibility) at the time of service divided by the total number of claims processed by the payer over the same period of time, as a percentage.

Why should Benefit Accuracy Rate be measured?

Benefit Accuracy Rate measures the percentage of instances where the health insurance company communicated the appropriate patient responsibility amount (i.e., co-pay, deductible, or co-insurance amounts) to the healthcare provider, based on the services rendered and the benefits that the patient is eligible for under their insurance policy. A high rate of incorrect patient responsibility information has a significant negative impact on both health plan member experience/service levels, as well as the service being provided to the healthcare provider (e.g., doctor, clinic, hospital, etc.). Errors here can also impact employee productivity and rework rates within claims operations, as additional payments may have to be collected from customers (or paid out to customers) following the communication of an incorrect patient responsibility amount. To remedy inaccuracies here, look to pre-adjudicate claims (and/or adjudicate them in real-time) to estimate patient responsibility, or implement more rigorous methods for verifying patient eligibility.


Download a Sample Benefit Accuracy Rate

Frequently Asked Questions

Q: How do you collect and validate your data?

A: From real-world consulting engagements with Fortune 500 leaders. We’ve spent 25 years conducting original research and anonymizing data from our engagements with top companies around the world. Every single data point we collect is scrutinized by our analysts to conform to established baselines and our rigorous in-house validation process. We won’t serve it up to you unless it meets our tough standards for utility and value.

Q: How much information will my Benchmarking Report contain?

A: Enough to produce a useful benchmark. And rest assured that it’s all current, validated, and useful. We only include data that’s been collected in the last five years. And while sample sizes vary by KPI, the average is 25, and the high end can surpass 1,000.

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A: Every year. We’re constantly gathering, scouring, and processing new data. We update our reports based on trends our analysts detect in the data, as well as the demand from our consulting clients and customers like you.

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