title: Optimizing claims payment for successful risk management.
abstract: Disputed claims and delayed payments are among the principal sources of provider and vendor dissatisfaction with managed care payment systems. Timely and accurate claims-payment systems are essential to ensure provider and vendor satisfaction, fiscal stability, and regulatory compliance. A focused analysis of conditions contributing to late payment of claims can disclose problems in provider, vendor, or payer operational and billing procedures, contracting processes, information systems, or human resources management. Resolution of these conditions equips claims-processing staff with tools to resolve problem claims promptly, thereby lowering costs.
authors.affiliation: Health Care Administration Program, California State University Long Beach, Newport Beach, California, USA.
authors.forename: Janice
authors.initials: J
authors.lastname: Frates
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Ginty
authors.forename: Linda
authors.initials: L
authors.lastname: Baker
mesh_terms: D000068:Accreditation; D005375:Financial Audit; D007345:Insurance Claim Review / Q000458:organization & administration*; D008329:Managed Care Programs / Q000191:economics*; D011340:Problem Solving; D012308:Risk Management / Q000458:organization & administration*; D013995:Time; D014481:United States