The report card is broken down for the following health insurance companies (Aetna, Anthem, CIGNA, HCSC, Humana, Regence, UHC, and Medicare) in these categories:
- Payment Timeliness
- Payer claim received date, first Remittance response time
- Cash Flow
- Cash flow analysis, % of claim lines paid $0, EFT adoption rate, EFTs still receiving checks
- Accuracy
- Allowed amount, Contracted fee schedule match rate - major CPT code categories - match rate by state, First ERA accuracy
- Prior Authorization
- Prior authorization frequency
- Claim Edit Sources and Frequency
- Source of payer, Total number of claim edits
- % of total claim lines reduced to 0 (disclosed claim edits, undisclosed claim edits, disclosed and undisclosed claim edits)
- % of edited claim lines reduced to 0 (undisclosed claim edits)
- Denials
- % denied, Reason codes, Remark codes, % of reason codes reported with remark code
- Improvement of Claims Cycle Workflow
- CORE certification, Prior authorization, Claim acknowledgement.
To view and download the 2011 National Health Insurer Report Card, please click this link: 2011 National Health Insurer Report Card