Analytics Home
The ClaimHeader offers analytics in support of claims process best practices.
Perhaps one of the murkiest areas in claims is performance measurement. On the other hand,
the claims process is a data driven process -- which means performance can be measured.
Understanding, managing and improving it
requires data and the analytics to interpret the data. The ClaimHeader provides those
resources in this section:
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Claim Metric Definitions. How do payers define the metrics they use
to manage themselves? Are there 'standard' definitions for such metrics
as denial rate or EDI rate?
The simple answer is that there are industry standards but that they are not shared or widely
understood. Each Claim Metric definition includes a step through definition
of a particular claims metric, an explanation for how a particular metric is used in an
operational setting (incuding usage tips), a set of potential pitfalls, a description of variations, and
a set of implementation tips (including common data elements).
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Survey Results. As with most business processes, the claims process has
many aspects that can be measured across payers. For example, what is a typical EDI rate
for a payer? The ClaimHeader surveys both operational performance and other claim related areas and
shares signicant portions of these surveys. As noted in the survey section, we have processes in place
to protect the identities of payers while at the same time enabling them to gather information
to help better understand and manage their own operations.
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100 Claims -- Benchmark Library. Our experience with benchmarks has been that they can be quite confusing. Our 100 Claims Series
is intended to make it easy to gather and interpret claims process benchmarks. In a nutshell, if there were only 100 claims,
how many would be (UB92 versus HCFA), (EDI versus paper), (paid versus denied)...?
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Claim Term Glossary. The claims process, like many large processes, has its own language.
Our glossary is designed to make it easy to find and define claims process related terms and acronyms.