UnitedHealthcare received high marks from the American Medical Association (AMA) in its 2011 National Health Insurance Report Card.
The fourth annual report card evaluated seven national health insurance companies on the timeliness and accuracy of their claims processing based on a variety of payment, approval and process metrics.
UnitedHealthcare moved into the top spot among its industry peers on two metrics of high importance to physicians: Contracted Fee Schedule Match Rate, which indicates how often an insurer’s claim payment matches the contracted fee schedule; and Electronic Remittance Advice (ERA) Accuracy, which measures the rate at which the insurer’s allowed amount equals the physician practice’s expected allowed amount.
These are among the two leading criteria used to assess an insurer’s overall claims payment accuracy, according to the AMA.
“Physicians have told us that contract match rates and ERA transparency are very important to them, so reaching the No. 1 position in both of these areas is an important milestone in the service we deliver to care providers,” said Tim Kaja, president of Provider Service Operations at UnitedHealthcare. “Our high ranking illustrates the continued investments we are making in claims payment clarity, accuracy and transparency.”
UnitedHealthcare received strong scores on other metrics in the AMA Report Card, including percentage of claim lines denied at just 1.05 percent.
Since the AMA survey was launched in 2008, UnitedHealthcare has seen dramatic improvements in its rankings, which reflect the company’s continued investments in improving service to physicians.
The company has taken a number of steps over the last several years to improve how it works with physicians. In 2008, UnitedHealthcare began expanding its local market provider relations staff in communities around the country to support physician practices via one-on-one outreach. UnitedHealthcare also has led in the introduction of new technologies and systems that make practice management more efficient and predictable, such as health care ID cards that can be read by bar code scanners, real-time claim adjudication and electronic payments and statements.
As a result of these and other improvements, UnitedHealthcare’s physician satisfaction rate has risen to 90 percent based on tens of thousands of telephonic surveys completed by physician office staff. The company’s physician and hospital network also continues to grow and is the largest network on a single system available to consumers in the country, with more than 650,000 physicians and care professionals and 5,000 hospitals, representing 85 percent of all hospitals in the country.
“We share the AMA’s goal of increasing transparency and decreasing administrative burden within the health care industry,” said Reed Tuckson, M.D., UnitedHealth Group executive vice president and chief of medical affairs. “Productive, collaborative relationships between physicians and health insurers are important if we are going to make progress together in modernizing our nation’s health care system.”
The full report is posted at http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/heal-claims-process/national-health-insurer-report-card.page
UnitedHealthcare is dedicated to helping people nationwide live healthier lives by simplifying the health care experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers. The company offers the full spectrum of health benefit programs for individuals, employers and Medicare and Medicaid beneficiaries, and contracts directly with more than 650,000 physicians and care professionals and 5,000 hospitals nationwide. UnitedHealthcare serves more than 38 million people and is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified Fortune 50 health and well-being company.