Timely Professional and Facility Medical Claim Processing

The percentage of clean professional and facility claims processed (paid or denied) within 30 calendar days of receipt, for those claims received in the measure data source time period. For example, if the measure data source time period is July, claims with receipt dates in July are examined to see what percentage of them have been paid within 30 days of the receipt date.  (e.g, claims received on July 1 and processed by July 31, claims received on July 31 and processed by August 30).  The data submission lag of 50 days allows for a minimum of 20 days for calculation and submission of the data.

Note: Claims include both Medical and Behavioral Health claims.

Measure Identifier: CLAIM.01

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