Cigna ranks No. 1 in doctor payment survey
NEW YORK May 2 (Reuters) - Cigna Corp. (CI.N) is the easiest U.S. health insurer for doctors to do business with, according to an analysis of medical claims and administrative efficiency released on Wednesday.
The analysis by athenahealth Inc., a claims-processing and physician services company, ranked Aetna Inc. (AET.N) as No. 2. The U.S. government's Medicare Part B program was third. Humana Inc. (HUM.N), which was No. 1 last year, placed fourth this year. UnitedHealth Group Inc. (UNH.N) was fifth.
Coventry Health Care Inc. (CVH.N) was last among large national publicly traded health insurers, but ahead of Champus/Tricare, a federal military insurance program. WellPoint Inc. (WLP.N) was next to last among public companies.
Overall, health insurers have improved operations since last year, the first year of the analysis, said Jonathan Bush, chief executive of athenahealth, a privately held company that performs back-office services for physicians.
"Your basic HMO has gotten more efficiently run in the last year," Bush said.
The analysis was compiled using a computer-based payment system from athenahealth and involved seven measures. The most heavily weighted were the length of time between the medical service and payment, how often a claim is resolved the first time and how frequently a claim is denied.
The analysis examined data from more than 8,500 doctors and other providers, including 28 million charge lines representing procedures performed in 2006, according to athenahealth.
Each doctor visit can have several charge lines for different procedures and tests. The rankings include national insurers with at least 120,000 charge lines.
Cigna jumped from No. 5 to No. 1 by ranking first in three categories: resolving claims on their initial submission; lowest percentage of claims denied; and the least amount of claims requiring extra documentation.
In the past two years, Cigna has expanded its electronic services, including a program that allows doctors to submit claims directly to Cigna instead of through a middleman, according to Karen Ferrell, senior vice president of national contracting and medical management.
Ferrell also said the company did research to identify the root causes of claim denials to smooth the process. The company acted after talking with physicians and hospitals in its network, Ferrell said.
"These quality improvements were not developed in a vacuum," Ferrell said.
Aetna was the quickest at resolving claims, at 29.8 days, followed by Humana at 30.6 days and Cigna at 31.9 days. Champus/Tricare took the longest, at 39.9 days on average.
Bush said insurers have improved efficiency by building and improving electronic systems.
Companies that merged had trouble integrating claim payment systems, Bush said, which may help explain why two of the biggest acquirers -- WellPoint and UnitedHealth -- ranked in the bottom half of the overall rankings.
"That harmonization that you need to do internally creates a huge amount of problems," Bush said.
One emerging problem for doctors is the increased number of new high-deductible, lower-premium health plans, which increases out-of-pocket expenses that doctors must collect.
Insurers have been slow to develop systems to help make sure doctors know how much to collect from patients when they visit, Bush said.
Complete rankings can be viewed at www.athenaPayerView.com.
((Reporting by Lewis Krauskopf, editing by J.S. Benkoe; Reuters Messaging: Lewis.Krauskopf.reuters.com@reuters.net; lewis.krauskopf@reuters.com; 646-223-6082)) Keywords: HEALTHINSURERS SURVEY/
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