The AMA’s third “report card” on private payors also estimated that if claims processing accuracy were improved by just 1 percent, $777.6 million a year could be saved in unnecessary administrative costs, while 100 percent accuracy could save up to $15.5 billion a year.
Of seven private payors measured, Coventry Health Care had the best record, with an accuracy rating of 88.41 percent, and Anthem Blue Cross Blue Shield was the worst, with an accuracy rating of 73.98 percent. The other rated insurers were Aetna, Cigna, Health Care Service Corp., Humana and UnitedHealth Group.
This was the first time the AMA report card measured the accuracy of claims processing.
The report card also measured payors on:
- Reporting the correct contracted fees. This information was correctly reported 78-94 percent of the time in 2010, compared with 62-87 percent of the time in the 2008 report card.
- Frequency of denials. There is wide variation in the frequency of denials, ranging 0.7-4.5 percent. The most cited reason was lack of eligibility.
- Transparency. Payors made significant improvements since 2008 in disclosure of vital policies and information for physicians on their websites.
Read the AMA release on claims processing.
Read the National Health Insurer Report Card.
