Aetna ranks No. 1 in business dealings with physicians, according to athenahealth's PayerView rankings.
Among other performance criteria that put Aetna in the top spot, athenahealth found that the insurer pays claims faster than any other national payer.
Last year's No. 1 payer was CIGNA Healthcare.
Athenahealth, which provides Web-based services for physician practices, and Physicians Practice, a practice management journal for physicians, released the third annual PayerView Rankings Thursday.
This year's rankings used athenahealth claims performance data from more than 12,000 medical providers representing more than 30 million medical charge lines in 2007.
The data is derived from athenahealth's national on-demand athenaNet system database and ranks health insurers according to specific measures of financial, administrative performance and medical policy complexity. Athenahealth evaluated 137 national, regional and government payers.
The rankings include national payers with at least 120,000 charge lines of data, regional payers with a minimum of 20,000 charge lines and medical services billed from 39 states to payers in 45 states.
"Aetna is committed to better serving physicians and hospitals. We have made tremendous progress in simplifying business transactions, delivering quality service and information and making our business processes as transparent as possible to physicians doing business with us," said Ronald A. Williams, Aetna's Chairman and CEO.
"We commend Aetna for their progress in improving what should be any insurer's core competency: paying insurance claims accurately and promptly," said William F. Jessee, MD, president and CEO of the Medical Group Management Association, which serves 21,500 members at 13,500 organizations. "We hope other payers will similarly work to reduce the crushing economic burden imposed by their unnecessarily complex administrative policies and flawed claims payment processes."
Key findings from PayerView include:
- Aetna's greatest performance gain was realized from a 10.6 percent reduction in its denial rate, which also provided Aetna with the best denial rate among national payers. Across the other metrics, Aetna either maintained or improved its rank - including fastest payment to providers for the second straight year, which gave it the edge over CIGNA Healthcare.
- Medicaid-New York ranked last for the third straight year in the days in account receivable metric (DAR). That program took an average of more than 137 days to pay a medical claim submitted by an athenahealth client, compared to an average of 33 days for national commercial carriers.
- Patient liability for the national payers was only up slightly, at 0.4 percent compared to a 19 percent increase experienced the year prior. Both Humana and UnitedHealthcare launched new real-time adjudication projects with athenahealth in 2007 to address the growing demand on providers to collect payment from patients with new consumer-centric benefit plans.
- The Centers for Medicare and Medicaid Services National Provider Identifier initiative confused providers in 2007 concerning which payers would adhere to the original May 23, 2007 deadline and what each payer's contingency plans were. Payers had varying instructions for providers on how to exchange NPI information, which was needed for a payer to be able to process a medical claim - this resulted generally in increased denial rates and multiple submissions to resolve. While this impact was still small in 2007, the industry may feel the full impact in 2008 when the requirement officially goes into effect.