Paying Claims
2024-25 Edition
Why is it important to get your claims paid correctly?
Your claims need to be paid quickly and correctly. Insurance and payment arrangements can be confusing. It can be time consuming and frustrating if you have to work with the insurance company to fix incorrect claim payments.
What can health plans do to make sure they pay claims correctly and quickly?
Highly rated plans put training and business systems in place to make sure that their staff process and pay claims quickly and correctly. The plan should also quickly fix incorrect claims payments.
What do the stars mean?
A higher score means more HMO and PPO members said their claims are getting paid correctly and quickly.
The scores are based on information from a survey of a sample of at least 100 health plan members who contacted their plan in 2022 and 2023.
Data Disclaimer
The data source for data for the Report Cards is Quality Compass® 2024 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass® 2024 includes Healthcare Effectiveness Data and Information Set (HEDIS®) and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors. NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass and HEDIS are registered trademarks of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
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