Claim Metric Definitions Home
The ClaimHeader maintains an ongoing list of claims process related metrics.
New metrics and updates to current metrics are posted monthly.
The claims process is a data driven process -- which means performance can be measured.
To that end, we have developed a set of metrics and respective definitions
for each. These have evolved from our 15 years of experience working in and for
health plans.
In addition to the metrics themselves there is also a set of notes and caveats
to help frame some of the metrics in terms of assumptions used and purpose. This
is also listed below.
Other Items List
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Notes and assumptions used in developing the metrics. (updated 2/18/07)
Metric List
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The total count automatically processed original claims divided by the total count of original claims. (updated 2/1/07)
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The total amount of allowed dollars denied divided by teh total amount of allowed dollars. (updated 2/1/07)
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The total count EDI (electronically) submitted original claims divided by the total count of original claims. (updated 4/26/07)