Instant insurance claim adjudication works well for gyns

October 1, 2009

Gynecologists are more successful with instant claims adjudication than any other group of specialists, with 89% of gynecology claims resolved in less than 10 seconds

Gynecologists are more successful with instant claims adjudication than any other group of specialists, with 89% of gynecology claims resolved in less than 10 seconds, according to a report on one insurer's program in American Medical News (8/17/2009). Real-time adjudication allows a claim to be submitted and settled before a patient leaves the office. Though the idea of quick settlements is attractive to physicians and patients, most physicians are not signing on to insurers' real-time adjudication systems.

Observers have offered several reasons for this lack of interest. For one, implementing a program can be complicated, requiring a physician's office to change how it handles billing and collections. For another, most specialists find that almost half of claims cannot be processed immediately and are handled later by the insurer. In addition, because adjudication systems are not standardized, physicians may have to customize their processes for each insurer. Another barrier to using real-time claims adjudication is that it adds a step to the usual patient and provider/office interactions. Finally, because only a few insurers offer the service, many physicians believe that adopting real-time adjudication isn't important.