Administrative waste, error rates, slow payment — health insurers are usually associated with negative terms, but according to the American Medical Association's fifth annual National Health Insurer Report Card, the "chaotic health insurance billing and payment system" is improving.
The NHIRC is based on 1.1 million electronic claims for roughly 1.9 million medical services submitted in February and March 2012 from 380 different physician practices. The health insurers included on the report card were Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corporation, Humana, Regence, UnitedHealthcare and Medicare.
Most notably, error rates for private health insurers on paid medical claims dropped from 19.3 percent in 2011 to 9.5 percent in 2012, resulting in roughly $8 billion in savings. Here are 32 other statistics from this year's NHIRC.
Cash flow analysis
On what percentage of claims was the first payment on the claim received within 0 to 15 days?
Aetna: 63.4 percent
Anthem: 95.01 percent
Cigna: 95.32 percent
HCSC: 90.44 percent
Humana: 94.21 percent
Regence: 81.28 percent
United: 85.79 percent
Medicare: 94.65 percent
Timeliness
What is the median time period between the date the physician claim was received by the payor and the date the payor produced the first electronic remittance advice?
Aetna: 14 days
Anthem: 7 days
Cigna: 7 days
HCSC: 6 days
Humana: 6 days
Regence: 9 days
United: 11 days
Medicare: 14 days
Accuracy
On what percentage of claim lines does the payor's allowed amount equal the physician practice's expected allowed amount?
Aetna: 95.39 percent
Anthem: 88.59 percent
Cigna: 90.62 percent
HCSC: 87.57 percent
Humana: 87.36 percent
Regence: 89.02 percent
United: 98.32 percent
Medicare: 99.48 percent
Denials
What percentage of claim lines submitted are denied by the payor for reasons other than a claim edit?
Aetna: 4 percent
Anthem: 5.07 percent
Cigna: 1.39 percent
HCSC: 3.06 percent
Humana: 1.97 percent
Regence: 1.38 percent
United: 1.71 percent
Medicare: 3.78 percent
The NHIRC is based on 1.1 million electronic claims for roughly 1.9 million medical services submitted in February and March 2012 from 380 different physician practices. The health insurers included on the report card were Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corporation, Humana, Regence, UnitedHealthcare and Medicare.
Most notably, error rates for private health insurers on paid medical claims dropped from 19.3 percent in 2011 to 9.5 percent in 2012, resulting in roughly $8 billion in savings. Here are 32 other statistics from this year's NHIRC.
Cash flow analysis
On what percentage of claims was the first payment on the claim received within 0 to 15 days?
Aetna: 63.4 percent
Anthem: 95.01 percent
Cigna: 95.32 percent
HCSC: 90.44 percent
Humana: 94.21 percent
Regence: 81.28 percent
United: 85.79 percent
Medicare: 94.65 percent
Timeliness
What is the median time period between the date the physician claim was received by the payor and the date the payor produced the first electronic remittance advice?
Aetna: 14 days
Anthem: 7 days
Cigna: 7 days
HCSC: 6 days
Humana: 6 days
Regence: 9 days
United: 11 days
Medicare: 14 days
Accuracy
On what percentage of claim lines does the payor's allowed amount equal the physician practice's expected allowed amount?
Aetna: 95.39 percent
Anthem: 88.59 percent
Cigna: 90.62 percent
HCSC: 87.57 percent
Humana: 87.36 percent
Regence: 89.02 percent
United: 98.32 percent
Medicare: 99.48 percent
Denials
What percentage of claim lines submitted are denied by the payor for reasons other than a claim edit?
Aetna: 4 percent
Anthem: 5.07 percent
Cigna: 1.39 percent
HCSC: 3.06 percent
Humana: 1.97 percent
Regence: 1.38 percent
United: 1.71 percent
Medicare: 3.78 percent
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