Claims Quality Assurance: Claims Financial Accuracy

Percent of dollars accurately paid for provider claims during the measurement period by claim type: A. Professional Claims Excluding Behavioral Health; B. Facility Claims Excluding Behavioral Health; C. Pharmacy Point Of Service (POS) Claims; D. Non-Emergent Medical Transportation (NEMT) Claims; E. Behavioral Health Professional Claims; F. Behavioral Health Facility Claims.

Note: It is measured by evaluating dollars overpaid and underpaid in relation to total paid amounts taking into account the dollar stratification of claims.

Measure Identifier: CLAIM.26

Please see Report Details below for more information on selected subgroups, organizations, and aggregation.