Aetna, Cigna retain best payment records.

Aetna has taken over from Cigna as the fastest and most accurate national insurer when it comes to paying physicians, according to the third annual ranking of payer performance by one of the nation's largest physician management companies.

Cigna achieved the top rank in 2006, and Aetna was No. 2, having moved up from the fourth spot in the 2005 survey by AthenaHealt.

The 2007 data are based on 30 million charge lines collected by AthenaHealth, and cover 137 national, regional, and government payers and 12,000 medical providers. The company, which is based in Watertown, Mass., collected almost $3 billion for its 980 physician clients in 2007.

According to the company, several trends were apparent in the data. Payers have moved to make Web portals more available to physicians, and they've become more proactive about contacting physicians with guideline changes. This has resulted in an almost 3% drop in the number of days that claims are in accounts receivable, at least for regional payers.

Claims denial and resubmission rates increased, however, partly due to problems implementing the new National Provider Identifier number required by Medicare. The full impact of that transition may not be felt until this year, according to AthenaHealth.

After Aetna and Cigna, the top performers were Humana, Medicare Part B, UnitedHealth Group, WellPoint, Coventry Health Care, and Champus Tricare. Humana and Medicare were the top two payers in 2005; United, Wellpoint, Coventry, and Champus have more or less held steady.

Dr. William F. Jessee, who serves as president and CEO of the Medical Group Management Association, in a statement that his organization commends Aetna for its progress "in improving what should be any insurer's core competnecy: paying insurance claims accurately and promptly."

In a statement, Aetna CEO Ronald A. Williams acknowledged the achievement but pledged continued improvement.

"While we are pleased that the progress we have made has been recognized, we are committed to continuous improvement in this area," Mr. Williams said.

Rankings are calculated by scores given to performance in seven areas. If a payer paid quickly and fully, it tended to receive a higher ranking overall.

Fifty-eight percent of the score came from days in accounts receivable (DAR), first pass resolve rate, and percentage of billed charges deemed the patient's responsibility.

Physicians have a greater collections burden when payers ask patients to foot more of the bill. There was a 19% increase in patient liability in 2006, but it only rose 0.4% in 2007. Increased availability of real-time claims adjudication has helped cut the physician collection burden, according to AthenaHealth.

Aetna's DAR was 26.9 days, compared with 32.6 for Cigna, and 35.7 for Coventry, which holds the No. 8 overall position. Blue Cross Blue Shield of Rhode Island had the lowest DAR for the second year in a row, at 15.8 days.

Denial rate is also an important metric used in the ranking. Aetna had the lowest denial rate among national payers, at about 6%. The highest denial rate--38%--was at Health Choice Arizona. The lowest denial rate overall was 3.17%, at Blue Cross Blue Shield of Rhode Island.

The New York state Medicaid program came in for special criticism. It lagged in most of the key measures.

The program had the highest DAR of any payer--for the second year running--coming in at 137.3 days in 2007, compared with the national median of 35.4. New York Medicaid also had the lowest first pass resolve rate, at 57%, compared with 97% for Blue Cross Blue Shield of Ohio, the top performer in that category.

According to AthenaHealth, the New York program "ranked at the bottom on the clarity of why the program rejects a medical claim."

The best overall Medicaid program, in South Carolina, had a DAR of 40 days, and a first pass resolve rate of 92%.

The number two Medicaid performer, the North Carolina program, had similar rates.

The rankings are posted at www.athenapayerview.com.

Of National Insurers, Aetna Pays Quickest

                      Days in Accounts Receivable

Aetna                                   26.9 days
Humana                                  30.1 days
Cigna                                   32.6 days
Medicare Part B                         34.5 days
UnitedHealth Group                      35.7 days
Coventry Health Care                    35.7 days
WellPoint                               36.2 days
Champus Tricare                         38.0 days

Note: Based on 2007 data for 30 million charge lines.

Source: AthenaHealth

Note: Table made from bar graph.

BY ALICIA AULT

Associate Editor, Practice Trends