A report card on health insurers' claims processing practices shows wide performance variations among seven national commercial payers. As a group, they also have considerable room for claims processing improvement, according to the American Medical Association's third annual National Health Insurer Report Card.

In total, 20 percent of physician claims are processed inaccurately, according to the AMA, which claims fixing that problem could save $15.5 billion annually. Two thirds of the studied insurers are below 90 percent in the percentage of claim lines where the payer's allowed amount equals the contracted fee schedule rate by major CPT code categories.

The seven insurers in the report card are Aetna, Anthem BCBS, Cigna, Coventry, Healthcare Services Corp., Humana and UnitedHealth Group.

Some of the national commercial insurers pay much faster than others. While Aetna and UnitedHealth take at 10 or more days to produce the first electronic remittance advice after receiving a claim, Coventry takes only five and Cigna takes six days.

Six of the insurers disclose at least 90 percent of the time the date a claim was received when sending electronic remittance advice or explanation of benefit transactions to providers. Anthem provides such information only 52 percent of the time.

Only three of the insurers--Aetna, Health Care Services and UnitedHealth--send electronic funds transfer payments to physicians at least 80 percent of the time. Coventry lags considerably beyond all others at 30 percent.

The AMA compiled the report card using data from The Frank Cohen Group, a Clearwater, Fla.-based data analytics firm, and National Healthcare Exchange Services, a Sacramento, Calif.-based vendor of revenue cycle management software and services.

More information on the 2010 National Health Insurer Report Card is available at ama-assn.org/go/reportcard.

--Joseph Goedert

 

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