Managed Care - August 2012 - (Page 14)
Humana UnitedHealthcare C O M P E N S AT I O N M O N I T O R 100% AMA applauds claim processing improvement 90% hysicians are a tough audience for clinician executives at health insurance plans. We’ve been reporting on the doctor-plan tension for a long time, and 70% have excitedly — but always warily — noted any sign of rapprochement. (For instance here, way back in 1998: 60% http://preview.tinyurl.com/Managed-Care-Truce.) One of the things that obstructed such cooperation 50% was physicians’ feeling that plans weren’t paying them on time. Another was the belief that they were paying 40% them less than they were due. That sort of thing will tick someone off. However, according to the 2012 National 30% Insurer Report Card (http://tinyurl.com/Claims-Study) released by the American Medical Association, insurers 20% have made progress in paying claims. This year, they paid the wrong amount 9.5 percent of the time; last year it was 19.3 percent. 10% Officials at America’s Health Insurance Plans say part of the reason for the better scores is that plans 13.95% 0% 2010 2012 gave doctors more accurate2011 “This survey data are data. more comprehensive and reflective of what is already happening in the marketplace,” says Robert Zirkelbach, spokesman for America’s Health Insurance Plans. 7.17% 6.70% 6.15% “Health plans are doing their part 4.92% by collaborating 5.20% with providers and investing in new technologies to improve the process for submitting claims electronically and receiving payments quickly. At the same time, more work needs to be done to reduce the number of claims Cigna Humana UnitedHealthcare submitted to health plans that are duplicates, inaccurate, or delayed.” 80% P Meeting expectations “On what percentage of claim linesAetna the payer’s does Anthem allowed amount equal the physician practice’s expected allowed amount?” Cigna 100% 90% 80% 70% Humana UnitedHealthcare UnitedHealthcare Cigna Aetna Humana Anthem 60% 50% 40% 30% 20% 10% 0% 2010 2011 2012 More prior authorization Percent of claims 16% 14% 12% 10% 8% 6% 4% 2% 0% Aetna 3.50% 4.68% 3.10% 2.29% 16% Anthem 14% Cigna 12% 10% 8% Source: 2012 National Health Insurer Report Card, American Medical Association 2011 2012 13.95% 6.15% 7.17% 5.20% 4.92% 6.70% Humana UnitedHealthcare 6% 4% 3.50% 2% 0% 6.15% 4.68% 3.10% 2.29% 7.17% 14 MANAGED CARE / AUGUST 2012 2011 2012 Aetna Anthem Cigna
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