PayerView 2013

2013 Overall Top 10 Performers

#1 Humana
#2 Medical Mutual of Ohio
#3 Healthpartners
#4 BCBS-MA
#5 UnitedHealthcare
#6 Medicare B-MO
#7 Aetna & Aetna-US Healthcare
#8 BCBS-DC
#9 MVP Health Plan of NY
#10 Medicare B-CT

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PayerView 2013:
Signs of Future
Challenges

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2013 Highlights

  • With few exceptions, the top tier of payers shifted from 2011 to 2012, illustrating the usual high level of competition.
  • A change in metric weighting, driven by the provider need for more accurate information, resulted in mostly small movements among the top ten payers, with a few large shifts.

PayerView provides unprecedented insight into health care reimbursement.

The 2013 PayerView report, which covers industry trends in 2012, reveals several areas where the industry might be headed for problems:

  • The impact of ICD-10 on claims resolution
  • Increasing problems from Medicaid underperformance as Medicaid rolls grow
  • The burden on providers to collect more from their patients
  • Delayed movement to electronic enrollment
  • Administrative burden and transparency problems with pay-for-performance programs

As these problems become more prominent, it will become increasingly important for providers and payers to work closely together to find solutions. The better they understand what is happening, and the more closely they work together, the better the chances for solving these problems. PayerView encourages this dialogue by providing insight into transactions and objective data that shine a light on opportunities for improvement.

Since its launch in June 2006, PayerView has provided a unique framework that systematically addresses unnecessary administrative complexity between payers and providers. PayerView is designed to evaluate the performance of each payer based on a number of key metrics, which, when combined, provide an overall ranking that quantifies the ease of doing business with that payer.

All data comes from the actual claims performance of payers that work with athenahealth providers and reflects athenahealth's experience in dealing with individual payers across the U.S. While our claims billing data set isn’t perfect—as no single set can be—through PayerView we strive to bring transparency and process integrity to the analysis of the provider-payer relationship.

PayerView is a natural product of the unique data that athenahealth continuously compiles and manages on behalf of its clients. Unlike other medical billing, EHR, and patient communication solutions, athenahealth uses a combination of centrally hosted, cloud-based software tools and robust back-office services. Because our 40,000 providers share a single cloud-based instance of software, data and intelligence are pooled through a powerful network effect. This means that every detail of every billing transaction—patient eligibility check, claim submission, processing time at the payer, claim denials, receipt of electronic or paper remittance, and more – is captured electronically across our national network of providers.

We distill our information into quantitative rankings. Since its launch in June 2006, PayerView has provided a unique framework that systematically addresses unnecessary administrative complexity between payers and providers. PayerView is designed to evaluate each payer's performance based on a number of key metrics which, when combined, provide an overall ranking that quantifies the ease of doing business with that payer. All data come from the actual claims performance of payers that work with athenahealth providers, and reflect athenahealth's experience in dealing with individual payers across the U.S. While our claims billing data set isn't perfect—as no single set can be—through PayerView we strive to bring transparency and process integrity to the analysis of the provider-payer relationship.

To learn more, click the tabs above or read our whitepaper, PayerView 2013: Signs of Future Challenges

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PayerView 2013: Signs of Future Challenges
Thursday, July 11, 12:15 pm

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From the Blog

June 26: PayerView: An Annual Transparent Look at Payer Performance and Medical Billing. Read

Because of the changing dynamics in health care, we explored a few new metrics in this year’s PayerView report. We looked at ease of access to information on pay-for-performance programs, delivery of accurate co-pay amounts, and provider enrollment efficiency. While we did not include the new evaluationareas as part of payers’ overall rankings, we are sharing the results and calling on payers to step up in areas like electronic enrollment and benefit accuracy to ensure providers get paid faster and more efficiently.

Todd Rothenhaus, M.D.,
Chief Medical Officer, athenahealth


Read our Metric Data and PayerView Disclaimer.


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