Several major commercial insurers are paying claims faster, but their claims processing error rates are increasing, according to an annual report of insurer performance from the American Medical Association.

The fourth annual National Health Insurer Report card tracks the performance of Aetna, Anthem Blue Cross Blue Shield, CIGNA, Health Care Service Corp., Humana Inc., The Regence Group and United Healthcare, along with Medicare. The study analyzed a random sample of 2.4 million electronic claims for about 4 million medical services submitted in February and March of 2011 from more than 400 practices in 42 states. The findings:

* Studied commercial insurers had an average claims processing error rate of 19.3 percent, up 2 percent from last year. UHC led the way with an accuracy rate just above 90 percent while Anthem was at the bottom with 61 percent.

* Studied insurers made no payments on nearly 23 percent of submitted claims, most commonly because patients with high deductible plans had not hit their out-of-pocket limit and were responsible for payment. The AMA advocates real-time claims processing services, which would alert providers to collect payment at the point of care.

* Aetna, Anthem, HCSC and UHC have cut their denial rates substantially in the past year, while Cigna continues to have the lowest rate at .68 percent. Lack of patient eligibility continues to be the leading reason for denials.

* Cigna had the highest rate of claims requiring prior authorization, topping 6 percent.

* UHC has improved its rate of reporting correct contract fees for four straight years and most of the other commercial insurers have improved over time but dipped this year. Anthem was the exception, scoring 14 percent lower this year than it did four years ago.

* Cigna and Humana have cut in half their median time for issuing the first remittance response, to seven days and six days, respectively. Regence, in the study this year for the first time, is slowest at 15 days.

National Healthcare Exchange Services and the Frank Cohen Group helped AMA develop the report card. Complete results are available here.

 

Register or login for access to this item and much more

All Health Data Management content is archived after seven days.

Community members receive:
  • All recent and archived articles
  • Conference offers and updates
  • A full menu of enewsletter options
  • Web seminars, white papers, ebooks

Don't have an account? Register for Free Unlimited Access