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athenahealth’s claims report offers insight into payer performance
e-Reports, June 13, 2011
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A newly released report indicates health insurers are paying you in a timelier manner. The sixth annual PayerView® Rankings shows payers have made incremental progress in reimbursing physicians -- about one day faster. Furthermore, they are denying 5 percent fewer claims.

PayerView®, a project of athenahealth, Inc., and the practice management journal Physicians Practice, reviews payers’ performance based on actual claims data of athenahealth providers. The study ranks health insurers in areas of financial and administrative performance and transaction efficacy.

Payer Rankings
National Midwest
1. BCBS-RI 1. Aetna & Aetna-US Healthcare
2. Aetna & Aetna-US Healthcare 2. United Healthcare
3. Humana 3. Humana
4. United Healthcare 4. HealthPartners
6. HealthPartners 6. Medicare B-IL
7. Medicare B-WA 7. BCBS-IL
8. BCBS-OH 8. Medicare B-OH
9. BCBS-PA Capital Blue Cross 9. BCBS-IN
10. Medicare B-OR 10. Medicare B-MI

This year, Aetna moved up to rank first in the Major Payer segment, which included Humana, Champus/Tricare, Cigna, HCSC, Medicare B, United Health Groups and Wellpoint. Aetna also ranked first in the National Commercial Payer segment, which included Humana, Cigna and UnitedHealthcare. However, Humana had the lowest days in accounts receivable (22.5 days) of the eight payers included in the Major Payer segment.

Payers also were measured on how well they adapted to electronic transactions. State Medicaid programs had the most difficult time and, given the poor quality of their electronic remittance advice transactions, physicians had to rely on paper remittances in some instances.

“PayerView® has developed into something that allows physicians to regain leverage with payers because they now have as robust of a data set as the payers have,” said Jonathan Bush, chairman and CEO of athenahealth.

The 2011 PayerView® Rankings tracked 2010 performance data from more than 27,000 providers representing more than 47 million charge lines and $9 billion dollars in services billed in 41 states. All figures for the rankings come from actual claims performance data of athenahealth providers and reflect athenahealth’s direct experience in dealing with individual payers nationwide.

Read the report on the athenahealth website.

Also, hear a discussion about payer performance during a free webinar hosted by athenahealth June 15 at 12:15 ET. Register here.

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