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Home / News & IndustryManaged Care Insight and Analysis
Updated: Sept. 9, 2008
Aetna Pays Medical Providers The Fastest Among National Commercial Insurers

Aetna pays medical providers the fastest among national commercial insurers according to athenahealth Inc., a provider of Internet-based business services to physician practices.

athenahealth Inc. released its third annual PayerView Rankings that placed Aetna as the new numberone overall ranking among national payers for their business dealings with physicians.

This year’s rankings are based on athenahealth claims performance data from more than 12,000 medical providers representing over 30 million medical charge lines for all four quarters of 2007, the company said.

The PayerView Rankings are designed to look at payers’ performance based on a number of categories, which combine to provide an overall ranking aimed at quantifying the "ease of doing business with the payer," athenahealth said.

According to the company, key findings and trends from the 2008 PayerView Rankings are:

  • 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 across the national payers. Across the other metrics, Aetna either maintained or improved its rank including the fastest payment to providers for the second straight year, which gave it the edge to surpass last year’s leader, CIGNA Healthcare.
  • Medicaid-New York ranked last for the third straight year in the days in account receivable metric among all payers ranked. That program took on average over 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 last year. 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 (NPI) initiative caused a great deal of confusion for 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 for how to exchange NPI information, which was needed for a payer to be able to process a medical claim – this resulted generally in increased denials 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.

Address: athenahealth Inc., 311 Arsenal St., Watertown, MA 02472; (800) 981-5084, www.athenahealth.com.


  This article was taken from:
The Executive Report on Physician Organizations

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