AHIP Survey Shows Sharp Rise in Electronic Claims

Feb. 8, 2013

The latest survey from America's Health Insurance Plans (AHIP) released February 5 shows the percent of claims submitted and processed electronically has more than doubled since 2002, from 44 percent to 94 percent in 2011.

Health plans are processing 93 percent of claims within 14 days of receipt, and 98 percent of all claims within 30 days, according to the most recent data. The percentage of claims automatically adjudicated, processed without manual intervention, has risen from 37 percent in 2002 to 79 percent in 2011.

AHIP reported that a significant percentage of claims are still received after 30 days, with 16 percent of electronic claims and 54 percent of paper claims submitted by health care providers more than 30 days after the service date.

The average cost of processing a claim in 2011 was $1.36 per claim, with the average adjudicated claim processed at $0.99 per claim.

AHIP's survey respondents estimate that 88 percent of all claims were paid on an in-network basis in 2012, up from 85 percent in 2008.