Q2 2006: Auto Adjudication Survey

SURVEY COMPLETED AND CLOSED. The AA survey included two questions.

Question 1. How long would it take to identify and implement initiative to improve your Auto-Adjudication Rate (AA RAte) by 5%?

1. ___ 3 months
2. ___ 6 months
3. ___ 1 year
4. ___ 2 years

Question 2. Rank the following in terms of negative impact on your Auto Adjudication Rate?

1. ______ Benefit plan complexity
2. ______ Provider contract complexity
3. ______ Data entry and input quality
4. ______ Other system constraints
5. __________________ Other

AA Survey: Question 1 Results

Most payers can increase their AA rate by 5 % in less than 6 months.

Question 1. How long would it take to identify and implement initiative to improve your Auto-Adjudication Rate (AA RAte) by 5%?

Summary. Most payers can increase their AA rate by 5 % in less than 6 months.

It has been said by a number of management gurus that the key factor which will determine which organizations will still be functioning in five years is the ability to quickly improve and change processes. Based on our survey results, healthcare payors may be more responsive in terms of changing their processes than they’re commonly given credit for being. Sixteen of the twenty one respondants (over 75% -- 21 useable responses, 32 total responses received, 350 plans surveyed) said they could increase their AA rate by 5% in six months or less. That’s pretty impressive when you consider that an initiative to increase AA typically passes through three steps: data analysis to identify an initiative, an approval process to initiate implementation, and an implementation process typically involving system resources. Executing on these steps within a six month window requires focus and coordination. On the other hand, five of the respondents said a five percent increase in AA would require a year or more. Without knowing more about the specific barriers these payors face, a starting point for speeding their AA improvement efforts is to review the three AA improvement steps to find the barrier.

AA Survey: Question 2 Results

Benefit Plan and Provider Contract Complexity have the biggest negative impact on auto-adjudication.

Question 2. Rank the following in terms of negative impact on your Auto Adjudication Rate?

Summary. Benefit Plan and Provider Contract Complexity have the biggest negative impact on auto-adjudication.

If you think benefit plan and provider contract complexity have the largest negative impacts on auto-adjudication for your health plan -- you’re not alone. Of the 22 useable survey responses (32 total responses received, 350 plans surveyed), twelve payors responded that benefit plan complexity had the largest negative impact on their auto-adjudication rate. Thirteen payors responded that provider contracts were the second largest negative impact on their auto-adjudication rate. If an adjudicated claim is a benefit plan and a provider contract coming together to create a finalized claim, the fact that these two are key process drivers (i.e. drive auto-adjudication) is no surprise. For those working on improving their AA rate, have a second look at the pend codes related to provider contracts and benefit plans (at the individual pend code level and as a group). Additionally, three payors responded that input quality had the largest negative impact and three others responded that system constraints were their biggest barrier. For payors with systems or data entry problems, review your data entry strategy with the various vendors (a number of excellent vendors exist) and/or review your system functionality with system vendors.