Not-For-Profit Health Insurance Companies

Health Insurance Plan of Greater New York: Claims Processed In-House (94-S-60)

The Health Insurance Plan of Greater New York (HIP) is a not-for-profit health insurance company that operates primarily in the New York City metropolitan area. Some of HIP's claims are processed in-house, while others are processed by outside contractors. We examined the in-house processing of claims for hospital services and found that the automated processing system was not adequately protected against unauthorized access. We also examined a statistical sampleof hospital claims that were processed in-house. We found that some claims were paid more than once, many claims were not processed in a timely manner, and procedures intended to prevent the payment of ineligible claims did not always function as intended.

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