Comparison of Claim-processing Health Insurance Systems
Part 1: The Basic Tools, Chapter 1: The Health Insurance Maze Page 8
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Table 2 - Comparison of Paper-based Claim-processing System with an Electronic System
| Issue | Current Paper-Based System | Electronic System |
| Consumer fills out claim forms | Yes, for each visit to a medical provider, each piece of medical equipment, and each medical procedure or test | No, claims can be filed electronically by the provider |
| Consumer photo-copies all medical bills | Yes, for each visit to a medical provider, each piece of medical equipment, and each medical procedure or test | No, bills can be permanently maintained on a computer or an electronic card |
| Cost | Enormously expensive in terms of the cost of paper-based claim-filing, record keeping and personnel | Potential savings of billions of dollars |
| Consumer mails claim forms (in some cases, to both primary and secondary insurers) | Yes, for each visit to a medical provider, each piece of medical equipment, and each medical test or procedure | No, all claims filed electronically |
| Consumer collects documentation, if necessary, for all routine claim problems | Yes, whenever the insurer denies a claim pending receipt of additional documentation or information | No, requests for additional documentation for routine claim problems directed to the provider |
| Consumer files claim appeals in regard to routine claim problems | Yes, whenever the insurer denies a claim pending receipt of additional documentation or information | No, claim appeals are filed electronically by the medi cal provider, not by the consumer |
| Consumer maintains extensive records and copies of bills, claims, and documents | Yes, for each visit to a medical provider, each piece of medical equipment, and each medical procedure or test | No, records per manently maintamed on a com puter or on an electronic card |
| Speed | Claim-processing may require four weeks for a routine claim; if a secondary insurer is involved, the process may require a month or two | Claims filed by the provider and re ceived by the in surer within a few seconds; payment made electronically |
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