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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