Claims Denial Rate (Medical/Health)
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 Denial Rate (Medical/Health). 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 Denial Rate (Medical/Health)?
The number of medical/health insurance claims filed by policyholders that are denied by the insurance company divided by the total number of medical/health claims processed by the payer over the same period of time, as a percentage.
Why should Claims Denial Rate (Medical/Health) be measured?
Health Insurance Claims Denial Rate measures the percentage of medical claims submitted by insurance policyholders, or members, that are denied by the insurance company. A higher than desired rate of denied medical claims can greatly diminish customer service levels, lead to rework and reduced capacity within the claims function, and may lead to costly disputes with healthcare providers (e.g., doctors, hospitals, etc.). Poor inbound claims data (submitted by healthcare providers) is a common reason for claims denials. Missing claim information (e.g., no social security number, missing billing modifier, no plan code, etc.), duplicate claims submissions, and out-of-date submissions (i.e., claim not filed within required timeframe) can all trigger claims denials and cause significant rework on both ends (i.e., for the insurance company and healthcare provider).
Download a Sample Claims Denial Rate (Medical/Health)
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