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).
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