Percentage of Claim Lines Paid $0
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 Percentage of Claim Lines Paid $0. 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 Percentage of Claim Lines Paid $0?
The total number of claims that were filed by healthcare providers, but for which the payer paid $0 due to disclosed and/or undisclosed claim edits (i.e., changes to claims reimbursement rules) divided by the total number of claims lines filed over the same period of time, as a percentage.
Why should Percentage of Claim Lines Paid $0 be measured?
The Percentage of Claim Lines Paid $0 measures the volume of individual medical claim line items that the insurance company did not pay out (partially or fully) to the submitting healthcare provider due to changes in claims reimbursement policies, relative to the total number of claims lines processed during the measurement period. Changes to claims reimbursement policies, disclosed or undisclosed, that impact claims payments to healthcare providers can lead to disputes between providers and health insurance companies, as well as between providers and policyholders/customers. These disputes drive higher administrative costs, diminish customer service levels, and reduce organizational capacity for both health insurance payers and healthcare providers.
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