Claims Auto-Adjudication 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 Claims Auto-Adjudication 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 Claims Auto-Adjudication Rate?
The total number of claims that are automatically adjudicated (i.e., those approved or denied automatically without need for manual intervention) divided by the total number of claims adjudicated (manual and automatic) over the same period of time, as a percentage.
Why should Claims Auto-Adjudication Rate be measured?
Claims Auto-Adjudication Rate measures the number of incoming medical/health insurance claims that are automatically approved or denied (i.e., auto-adjudicated) through a rule-based claims processing system as a percentage of the total number of medical insurance claims received and processed (manually and automatically) over the same period of time. Claims that are auto-adjudicated require no human interaction to process, and consequently cost less, are processed faster, and typically result in less errors than their manually-processed counterparts. Factors impacting health insurance claims auto-adjudication rate include the level of technology implemented by the health insurance payer, claim submission accuracy and completeness, the method of entry into the claims system (electronic vs. manual) and claim complexity (i.e., certain complex medical claims require human involvement).
Download a Sample Claims Auto-Adjudication 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.
Q: How often do you update your reports?
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.
Q: Your download-able reports look great. But I need something custom. Can you help?
A: Heck yes. Our crack research teams just love custom assignments, and would be delighted to perform targeted research tailored to your specific requirements. Find out just how fast and affordable this is: Email us (email@example.com) or call us at 866.650.2888 and one of our friendly professionals will be happy to answer all your questions.