Patient Eligibility Accuracy Rate

Benchmarking Report

Patient Eligibility 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 Patient Eligibility 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 Patient Eligibility Accuracy Rate?

The number of instances where the patient eligibility information initially returned by the health insurance company matched the final outcome of claim adjudication divided by the total number of claims adjudicated by the insurance company over the same period of time, as a percentage.

Why should Patient Eligibility Accuracy Rate be measured?

Patient Eligibility Accuracy Rate measures the overall quality and accuracy of the patient eligibility information provided to healthcare providers by insurance companies regarding medical services to be provided to patients. A high accuracy rate here is important, because it allows healthcare providers to identify and resolve any eligibility-related issues prior to performing the medical service, or prior to submitting the claim to the payer for processing (i.e., avoiding a denial or additional rework). A higher than desired rate of inaccurate patient eligibility information can greatly diminish customer service levels, lead to rework and reduced capacity within the claims function (and for administrative functions within healthcare providers), and may lead to costly disputes with healthcare providers (e.g., doctors, hospitals, etc.).


Download a Sample Patient Eligibility Accuracy Rate

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