ERA Transparency 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 ERA Transparency 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 ERA Transparency Rate?
The total number of electronic remittance advice (ERA) claim denial or adjustment messages provided by the insurance company that include clear, actionable items and explanations divided by the total number of ERA messages sent by the insurer to healthcare providers over the same period of time, as a percentage.
Why should ERA Transparency Rate be measured?
ERA Transparency Rate measures the overall quality of Electronic Remittance Advice (ERA) messages sent by insurance companies to healthcare providers. ERA claims adjustment or denial messages typically include information related to the adjudication of a medical claim, including reasons why the claim might have been denied (e.g., missing information, patient not eligible for services, etc.) and how to potentially correct that issue(s) to garner an approval from the insurance company. A high rate of unclear or unactionable ERA messages may create additional work for the healthcare provider and the claims processing function of the insurance payer. Low quality ERA messages 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.).
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