National Health Insurer Report Card

The AMA has released their 2011 National Health Insurer Report Card (NHIRC), which provides physicians and the general public with a reliable and defensible source of critical metrics concerning the timeliness and accuracy of claims processing by health insurance companies. Billions of dollars in lost physician revenue would be eliminated each year if third-party payers processed claims based on their contractual relationships.

The report card measures health insurance company’s performance based on:
• Payment Timeliness
• Cash Flow (Percentage of time a claim is paid on the first claim)
• Accuracy
• Administrative Requirements – Prior authorization
• Claim Edit Sources & Frequency
• Denials

ADVOCATE uses this data, as well as client specific data for each payer, to focus our claims monitoring systems on specific payer issues. Based on this advanced knowledge, systems are developed to detect, prevent, and reduce the issues from reoccurring. With these systems, we can greatly reduce the impact of the payer deficiencies identified in the National Health Insurer Report Card, and those identified by ADVOCATE, resulting in increased client revenue and a faster payment cycle.

Payers participating in the 2011 NHIRC include, among others, Aetna, Anthem, CIGNA Corp., Health Care Service Corporation (HCSC), Humana, Inc., The Regence Group and United HealthCare (UHC).

With best regards,
Kirk Reinitz, CPA
President & CEO