Percent of Claims Paid with No Contract Holder on File

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Wednesday, June 13, 2012 1:23:00 PM Categories: How Do You Compare?


Percent of Claims Paid with No Contract Holder on File

October 27, 2009

No claim should be paid unless a contract holder (employee or retiree) exists.  But, two-thirds of the plans we reviewed failed this most basic test. 

The chart below highlights the distribution of client plans according to the percent of claims paid with no contract holder present in the enrollment file.

Distribution of Claims without Contracts Incidence as a Percent of Paid Claims


The largest group of plans (32.61%) met the goal of 0% claim payment error.  Another 30.43% had an error rate below 0.5%.  However, an equivalent proportion (30.43%) exceeded the 0.5% error threshold.  Of this top group, 21.74% had over 1.0% error.  Each 1.0% error translates into an estimated $7000 for each 100 employees; or an amount equivalent to another employee contract.

The average error rate was 1.27% with the highest recorded error in our population coming in at 18.74%.

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