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PayerView 2015

This year's report ranks the performance of payers, based on metrics such as days in accounts receivable, first-pass claim resolution rate, denial rate, provider collection burden and more. 


Here are the results, sorted by overall payer rank from #1 to #166. For further information on this study, view the PayerView disclaimer and methodology.



Learn more about PayerView
  • #1 HealthPartners Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 28.7 days 88 28.5 days 87
    First Pass Resolve Rate 96.6% 26 97.2% 12
    Provider Collection Burden 29.1% 164 26.1% 141
    Denial Rate 2.8% 2 3.1% 2
    ERA Transparency 99.6% 19 99.0% 29
    Eligibility Accuracy 99.0% 7 99.1% 4
    Benefit Reliability 98.6% 45 97.8% 16
    Enrollment Efficiency 94.0% 8 94.0% 10
    Enrollment Turn Around Time 7 days 4 4 days 1
  • #2 Group Health Cooperative Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 31.1 days 105 25.1 days 59
    First Pass Resolve Rate 95.8% 54 94.6% 84
    Provider Collection Burden 10.0% 65 9.4% 57
    Denial Rate 3.9% 9 4.7% 31
    ERA Transparency 99.2% 26 99.2% 25
    Eligibility Accuracy 99.2% 5 99.0% 6
    Benefit Reliability 97.4% 54 97.7% 19
    Enrollment Efficiency 84.0% 53 67.0% 85
    Enrollment Turn Around Time - - - -
  • #3 Humana Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 27.9 days 84 23.5 days 40
    First Pass Resolve Rate 96.1% 40 96.2% 43
    Provider Collection Burden 11.2% 69 12.0% 68
    Denial Rate 5.6% 53 5.4% 50
    ERA Transparency 98.8% 38 98.2% 52
    Eligibility Accuracy 98.6% 22 98.8% 9
    Benefit Reliability 97.3% 55 97.2% 35
    Enrollment Efficiency 99.0% 2 99.0% 2
    Enrollment Turn Around Time 33 days 134 33 days 111
  • #4 BCBS-WA Regence Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 22.1 days 20 23.9 days 44
    First Pass Resolve Rate 95.3% 76 95.2% 75
    Provider Collection Burden 21.3% 109 22.1% 101
    Denial Rate 4.3% 16 4.6% 26
    ERA Transparency 99.1% 32 92.7% 110
    Eligibility Accuracy 97.9% 52 95.9% 75
    Benefit Reliability 97.8% 49 98.1% 10
    Enrollment Efficiency 84.0% 53 84.0% 44
    Enrollment Turn Around Time 16 days 25 28 days 97
  • #5 Maryland Physicians Care MCO Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 23.5 days 35 - -
    First Pass Resolve Rate 95.4% 73 - -
    Provider Collection Burden 1.0% 3 - -
    Denial Rate 5.7% 59 - -
    ERA Transparency 97.5% 73 - -
    Eligibility Accuracy 98.9% 10 - -
    Benefit Reliability - - - -
    Enrollment Efficiency 83.0% 63 - -
    Enrollment Turn Around Time 30 days 125 - -
  • #6 BCBS-MA Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 23.6 days 38 24.2 days 50
    First Pass Resolve Rate 95.9% 50 95.6% 64
    Provider Collection Burden 9.0% 60 8.3% 53
    Denial Rate 6.2% 77 5.2% 45
    ERA Transparency 98.9% 34 98.6% 42
    Eligibility Accuracy 97.4% 67 97.9% 27
    Benefit Reliability 95.6% 65 95.1% 59
    Enrollment Efficiency 92.0% 9 99.0% 2
    Enrollment Turn Around Time 30 days 125 25 days 84
  • #7 BCBS-LA Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 23.5 days 35 22.5 days 32
    First Pass Resolve Rate 95.6% 66 95.8% 53
    Provider Collection Burden 18.1% 95 18.3% 87
    Denial Rate 5.2% 39 5.8% 57
    ERA Transparency 98.4% 49 97.0% 71
    Eligibility Accuracy 98.0% 45 96.0% 72
    Benefit Reliability 96.7% 58 97.7% 19
    Enrollment Efficiency 78.0% 78 79.0% 63
    Enrollment Turn Around Time 20 days 36 7 days 10
  • #8 BCBS-PA Capital Blue CrossBlue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 19.6 days 3 20.1 days 9
    First Pass Resolve Rate 96.3% 34 95.3% 73
    Provider Collection Burden 12.3% 75 11.3% 65
    Denial Rate 3.6% 6 3.5% 7
    ERA Transparency 94.5% 112 94.6% 102
    Eligibility Accuracy 98.5% 24 98.3% 18
    Benefit Reliability 96.3% 61 97.2% 35
    Enrollment Efficiency 66.0% 108 66.0% 88
    Enrollment Turn Around Time 19 days 34 13 days 25
  • #9 BCBS-NC Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 24.2 days 48 21.4 days 17
    First Pass Resolve Rate 96.3% 34 96.4% 34
    Provider Collection Burden 16.7% 90 17.2% 83
    Denial Rate 4.6% 20 4.8% 33
    ERA Transparency 98.4% 49 96.5% 77
    Eligibility Accuracy 95.6% 104 95.1% 90
    Benefit Reliability 97.5% 52 97.3% 31
    Enrollment Efficiency 76.0% 84 76.0% 68
    Enrollment Turn Around Time 22 days 42 12 days 22
  • #10 BCBS-NC Blue Medicare Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 24.9 days 56 21.2 days 14
    First Pass Resolve Rate 94.3% 100 92.8% 114
    Provider Collection Burden 4.6% 44 4.5% 36
    Denial Rate 5.5% 48 4.5% 24
    ERA Transparency 95.9% 100 95.5% 92
    Eligibility Accuracy 99.1% 6 99.3% 3
    Benefit Reliability 99.3% 39 99.2% 1
    Enrollment Efficiency 59.0% 116 51.0% 140
    Enrollment Turn Around Time 27 days 60 21 days 73
  • #11 Medicare B-WA Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 23.9 days 42 25.9 days 75
    First Pass Resolve Rate 97.8% 3 97.0% 17
    Provider Collection Burden 23.6% 132 23.7% 112
    Denial Rate 4.3% 16 4.3% 19
    ERA Transparency 100.0% 1 98.4% 49
    Eligibility Accuracy 93.0% 139 93.7% 119
    Benefit Reliability 100.0% 1 96.2% 46
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #12 Cigna Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 24.1 days 46 23.5 days 40
    First Pass Resolve Rate 96.8% 21 96.6% 28
    Provider Collection Burden 17.4% 93 15.7% 79
    Denial Rate 4.1% 11 3.4% 5
    ERA Transparency 97.4% 77 94.8% 100
    Eligibility Accuracy 96.4% 88 97.4% 40
    Benefit Reliability 94.4% 89 96.2% 46
    Enrollment Efficiency 92.0% 9 99.0% 2
    Enrollment Turn Around Time 29 days 70 38 days 119
  • #13 Medicare B-GA Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 24.2 days 48 22.2 days 27
    First Pass Resolve Rate 96.9% 19 97.1% 14
    Provider Collection Burden 22.7% 119 23.2% 106
    Denial Rate 4.3% 16 3.7% 11
    ERA Transparency 99.8% 12 99.4% 22
    Eligibility Accuracy 93.5% 133 93.6% 120
    Benefit Reliability 100.0% 1 98.2% 8
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #14 Aetna & Aetna-US Healthcare Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 26.9 days 75 25.5 days 69
    First Pass Resolve Rate 95.6% 66 95.5% 68
    Provider Collection Burden 16.8% 91 15.4% 77
    Denial Rate 5.1% 34 5.4% 50
    ERA Transparency 98.8% 38 97.8% 59
    Eligibility Accuracy 98.3% 32 97.8% 30
    Benefit Reliability 93.9% 94 92.9% 83
    Enrollment Efficiency 84.0% 53 84.0% 44
    Enrollment Turn Around Time 24 days 51 24 days 81
  • #15 Medicare B-NC Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 22.3 days 23 22.1 days 23
    First Pass Resolve Rate 97.1% 14 97.7% 5
    Provider Collection Burden 24.6% 145 24.9% 134
    Denial Rate 5.3% 44 4.2% 17
    ERA Transparency 100.0% 1 100.0% 1
    Eligibility Accuracy 93.1% 137 93.5% 121
    Benefit Reliability 100.0% 1 98.1% 10
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #16 BCBS-PA Highmark Blue Shield Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 16.3 days 1 16.6 days 1
    First Pass Resolve Rate 95.4% 73 95.8% 53
    Provider Collection Burden 10.3% 66 10.4% 59
    Denial Rate 5.1% 34 6.1% 64
    ERA Transparency 97.0% 84 97.4% 63
    Eligibility Accuracy 91.4% 152 90.2% 140
    Benefit Reliability 97.5% 52 98.5% 3
    Enrollment Efficiency 80.0% 69 80.0% 58
    Enrollment Turn Around Time 6 days 2 6 days 4
  • #17 Medicare B-AL Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 26.1 days 67 23.5 days 40
    First Pass Resolve Rate 96.9% 19 96.8% 20
    Provider Collection Burden 24.4% 141 24.7% 130
    Denial Rate 4.7% 25 5.9% 60
    ERA Transparency 100.0% 1 98.7% 38
    Eligibility Accuracy 93.6% 128 94.0% 113
    Benefit Reliability 100.0% 1 98.3% 5
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #18 Medicare B-TN Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 21.9 days 15 21.6 days 19
    First Pass Resolve Rate 97.3% 8 97.0% 17
    Provider Collection Burden 23.1% 121 23.4% 108
    Denial Rate 4.1% 11 6.3% 72
    ERA Transparency 97.3% 80 99.5% 16
    Eligibility Accuracy 93.8% 125 94.1% 110
    Benefit Reliability 100.0% 1 98.0% 12
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #19 Medicare B-IN Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 21.9 days 15 23.3 days 37
    First Pass Resolve Rate 98.1% 1 97.9% 2
    Provider Collection Burden 24.1% 137 26.0% 140
    Denial Rate 3.2% 3 4.2% 17
    ERA Transparency 93.9% 117 98.7% 38
    Eligibility Accuracy 95.5% 105 95.6% 81
    Benefit Reliability 100.0% 1 97.8% 16
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #20 Unicare Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 23.9 days 42 28 days 85
    First Pass Resolve Rate 95.7% 60 96.4% 34
    Provider Collection Burden 5.9% 52 8.7% 55
    Denial Rate 6.7% 80 6.4% 74
    ERA Transparency 91.6% 130 96.5% 77
    Eligibility Accuracy 98.7% 14 97.3% 44
    Benefit Reliability 98.9% 43 96.8% 43
    Enrollment Efficiency 85.0% 46 83.0% 54
    Enrollment Turn Around Time 27 days 60 36 days 117
  • #21 Medicare B-SC Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 22.7 days 26 22.2 days 27
    First Pass Resolve Rate 96.3% 34 97.4% 8
    Provider Collection Burden 22.8% 120 23.7% 112
    Denial Rate 5.6% 53 4.4% 20
    ERA Transparency 99.8% 12 100.0% 1
    Eligibility Accuracy 93.6% 128 94.2% 108
    Benefit Reliability 100.0% 1 98.3% 5
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #22 Tufts Health Public Plans Inc Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 33.8 days 116 - -
    First Pass Resolve Rate 94.5% 96 - -
    Provider Collection Burden 0.9% 2 - -
    Denial Rate 5.6% 53 - -
    ERA Transparency 92.8% 122 - -
    Eligibility Accuracy 99.0% 7 - -
    Benefit Reliability 98.2% 47 - -
    Enrollment Efficiency 98.0% 7 - -
    Enrollment Turn Around Time 24 days 51 - -
  • #23 Medicare B-OR Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 25.3 days 59 22.2 days 27
    First Pass Resolve Rate 97.6% 4 97.7% 5
    Provider Collection Burden 23.9% 134 24.7% 130
    Denial Rate 5.9% 62 3.4% 5
    ERA Transparency 99.9% 7 98.9% 32
    Eligibility Accuracy 93.0% 139 94.5% 106
    Benefit Reliability 100.0% 1 97.4% 29
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #24 BCBS-SC Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 21 days 6 18.6 days 3
    First Pass Resolve Rate 95.0% 85 95.9% 50
    Provider Collection Burden 27.1% 160 26.3% 142
    Denial Rate 8.1% 103 7.8% 95
    ERA Transparency 99.2% 26 98.1% 54
    Eligibility Accuracy 98.3% 32 97.8% 30
    Benefit Reliability 97.6% 51 98.0% 12
    Enrollment Efficiency 72.0% 93 72.0% 75
    Enrollment Turn Around Time 20 days 36 26 days 89
  • #25 Medicare B-MO Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 23.6 days 38 21.5 days 18
    First Pass Resolve Rate 97.4% 7 98.0% 1
    Provider Collection Burden 25.6% 156 25.1% 136
    Denial Rate 8.1% 103 4.8% 33
    ERA Transparency 99.8% 12 99.9% 7
    Eligibility Accuracy 95.0% 110 95.5% 83
    Benefit Reliability 100.0% 1 97.7% 19
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #26 Tufts Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 29.7 days 96 33 days 102
    First Pass Resolve Rate 95.6% 66 95.1% 77
    Provider Collection Burden 3.5% 39 3.6% 33
    Denial Rate 3.8% 8 3.6% 9
    ERA Transparency 92.3% 125 91.4% 117
    Eligibility Accuracy 99.5% 2 99.6% 1
    Benefit Reliability 95.7% 63 95.6% 53
    Enrollment Efficiency 61.0% 114 61.0% 95
    Enrollment Turn Around Time 8 days 8 5 days 3
  • #27 Medicare B-AZ Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 27 days 77 24.1 days 48
    First Pass Resolve Rate 96.6% 26 97.0% 17
    Provider Collection Burden 24.6% 145 24.5% 126
    Denial Rate 6.1% 75 4.8% 33
    ERA Transparency 100.0% 1 99.7% 11
    Eligibility Accuracy 94.7% 116 95.2% 87
    Benefit Reliability 100.0% 1 97.3% 31
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #28 Medicare B-VA Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 26.4 days 70 25.7 days 72
    First Pass Resolve Rate 96.3% 34 96.7% 22
    Provider Collection Burden 23.5% 129 24.8% 133
    Denial Rate 4.9% 26 4.6% 26
    ERA Transparency 99.9% 7 100.0% 1
    Eligibility Accuracy 93.7% 127 94.3% 107
    Benefit Reliability 100.0% 1 97.4% 29
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #29 Harvard Pilgrim Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 30.5 days 103 26.6 days 79
    First Pass Resolve Rate 94.5% 96 94.6% 84
    Provider Collection Burden 8.9% 58 7.9% 50
    Denial Rate 5.1% 34 5.0% 41
    ERA Transparency 95.9% 100 91.8% 115
    Eligibility Accuracy 97.1% 76 97.1% 49
    Benefit Reliability 99.5% 38 99.0% 2
    Enrollment Efficiency 67.0% 105 66.0% 88
    Enrollment Turn Around Time 23 days 46 21 days 73
  • #30 Medicare B-MI Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 21.1 days 8 23.8 days 43
    First Pass Resolve Rate 97.5% 5 96.0% 46
    Provider Collection Burden 24.4% 141 24.3% 122
    Denial Rate 5.9% 62 6.1% 64
    ERA Transparency 99.9% 7 100.0% 1
    Eligibility Accuracy 91.5% 151 92.4% 128
    Benefit Reliability 100.0% 1 97.0% 40
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #31 BCBS-DC Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 22 days 19 22 days 22
    First Pass Resolve Rate 95.8% 54 95.4% 70
    Provider Collection Burden 13.8% 81 12.6% 71
    Denial Rate 4.6% 20 4.8% 33
    ERA Transparency 97.2% 82 99.0% 29
    Eligibility Accuracy 94.7% 116 96.7% 56
    Benefit Reliability 93.4% 96 93.4% 66
    Enrollment Efficiency 92.0% 9 92.0% 11
    Enrollment Turn Around Time 22 days 42 28 days 97
  • #32 BCBS-FL Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 22.1 days 20 22.5 days 32
    First Pass Resolve Rate 95.4% 73 94.7% 83
    Provider Collection Burden 18.5% 96 18.1% 85
    Denial Rate 8.3% 107 6.6% 78
    ERA Transparency 99.3% 24 89.5% 120
    Eligibility Accuracy 97.2% 73 98.4% 16
    Benefit Reliability 95.4% 66 95.3% 55
    Enrollment Efficiency 80.0% 69 80.0% 58
    Enrollment Turn Around Time 32 days 130 18 days 33
  • #33 Medicare B-NE Medicare-B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 22.1 days 20 - -
    First Pass Resolve Rate 97.9% 2 - -
    Provider Collection Burden 24.6% 145 - -
    Denial Rate 5.5% 48 - -
    ERA Transparency 97.3% 80 - -
    Eligibility Accuracy 93.2% 136 - -
    Benefit Reliability 100.0% 1 - -
    Enrollment Efficiency 55.0% 121 - -
    Enrollment Turn Around Time 29 days 70 - -
  • #34 Medicare B-AR Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 26.7 days 73 23.2 days 36
    First Pass Resolve Rate 97.0% 15 96.7% 22
    Provider Collection Burden 24.5% 143 24.4% 125
    Denial Rate 5.3% 44 3.6% 9
    ERA Transparency 97.1% 83 96.2% 84
    Eligibility Accuracy 95.2% 106 95.4% 86
    Benefit Reliability 100.0% 1 97.6% 23
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #35 Medicare B-IL Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 29 days 91 26.7 days 81
    First Pass Resolve Rate 96.7% 23 97.4% 8
    Provider Collection Burden 24.7% 149 25.6% 139
    Denial Rate 5.4% 46 6.8% 81
    ERA Transparency 99.2% 26 98.7% 38
    Eligibility Accuracy 93.9% 124 94.2% 108
    Benefit Reliability 100.0% 1 97.0% 40
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #36 Medicare B-MS Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 27.1 days 79 26.6 days 79
    First Pass Resolve Rate 96.0% 45 97.3% 10
    Provider Collection Burden 22.5% 116 23.0% 105
    Denial Rate 6.0% 71 4.8% 33
    ERA Transparency 98.7% 41 98.9% 32
    Eligibility Accuracy 94.6% 119 94.7% 98
    Benefit Reliability 100.0% 1 97.5% 25
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #37 BCBS-AR Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 21.7 days 11 19.8 days 7
    First Pass Resolve Rate 94.7% 93 93.4% 107
    Provider Collection Burden 22.2% 114 23.7% 112
    Denial Rate 6.7% 80 7.4% 91
    ERA Transparency 96.7% 89 97.9% 57
    Eligibility Accuracy 98.3% 32 97.9% 27
    Benefit Reliability 94.7% 88 96.0% 48
    Enrollment Efficiency 79.0% 75 79.0% 63
    Enrollment Turn Around Time 12 days 15 6 days 4
  • #38 Medicare B-OH Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 26 days 66 26.5 days 78
    First Pass Resolve Rate 97.0% 15 97.6% 7
    Provider Collection Burden 24.3% 139 24.6% 128
    Denial Rate 5.6% 53 4.6% 26
    ERA Transparency 99.8% 12 99.8% 9
    Eligibility Accuracy 91.4% 152 91.5% 136
    Benefit Reliability 100.0% 1 96.4% 45
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #39 BCBS-TX Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 23.4 days 33 24.1 days 48
    First Pass Resolve Rate 97.2% 11 96.6% 28
    Provider Collection Burden 29.5% 165 30.1% 148
    Denial Rate 5.6% 53 6.3% 72
    ERA Transparency 98.7% 41 98.3% 50
    Eligibility Accuracy 97.7% 56 97.9% 27
    Benefit Reliability 90.8% 104 90.3% 91
    Enrollment Efficiency 84.0% 53 84.0% 44
    Enrollment Turn Around Time 33 days 134 33 days 111
  • #40 Medicare B-MA Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 27.1 days 79 22.8 days 35
    First Pass Resolve Rate 96.4% 31 97.8% 4
    Provider Collection Burden 24.3% 139 25.0% 135
    Denial Rate 5.9% 62 5.2% 45
    ERA Transparency 98.6% 45 98.8% 35
    Eligibility Accuracy 93.6% 128 94.1% 110
    Benefit Reliability 100.0% 1 97.6% 23
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #41 Medicare B-CA Northern Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 21.6 days 10 21.3 days 16
    First Pass Resolve Rate 95.8% 54 97.1% 14
    Provider Collection Burden 25.1% 153 25.2% 137
    Denial Rate 7.8% 97 7.6% 93
    ERA Transparency 100.0% 1 99.8% 9
    Eligibility Accuracy 93.0% 139 93.4% 122
    Benefit Reliability 100.0% 1 97.7% 19
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #42 Medicare B-CT Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 24.5 days 53 22.4 days 30
    First Pass Resolve Rate 97.3% 8 97.3% 10
    Provider Collection Burden 24.0% 135 23.8% 117
    Denial Rate 4.6% 20 3.9% 14
    ERA Transparency 96.0% 97 98.7% 38
    Eligibility Accuracy 93.1% 137 93.8% 117
    Benefit Reliability 100.0% 1 95.8% 50
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #43 Medicare B-OK Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 30.9 days 104 24.5 days 53
    First Pass Resolve Rate 95.7% 60 96.8% 20
    Provider Collection Burden 24.6% 145 24.7% 130
    Denial Rate 6.0% 71 4.9% 39
    ERA Transparency 98.7% 41 98.8% 35
    Eligibility Accuracy 95.1% 108 95.6% 81
    Benefit Reliability 100.0% 1 97.2% 35
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #44 BCBS-PA Highmark BCBS Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 16.6 days 2 16.9 days 2
    First Pass Resolve Rate 94.9% 87 95.0% 80
    Provider Collection Burden 12.8% 78 11.8% 67
    Denial Rate 5.5% 48 7.1% 86
    ERA Transparency 98.0% 64 96.6% 76
    Eligibility Accuracy 89.7% 163 87.5% 144
    Benefit Reliability 95.4% 66 94.4% 63
    Enrollment Efficiency 80.0% 69 80.0% 58
    Enrollment Turn Around Time 6 days 2 6 days 4
  • #45 Medicare B-KY Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 24.4 days 50 24.8 days 56
    First Pass Resolve Rate 96.7% 23 96.5% 32
    Provider Collection Burden 25.9% 157 24.6% 128
    Denial Rate 4.9% 26 4.9% 39
    ERA Transparency 98.6% 45 99.1% 26
    Eligibility Accuracy 91.3% 154 91.9% 129
    Benefit Reliability 100.0% 1 95.2% 57
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #46 Medicare B-FL Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 26.9 days 75 25.4 days 66
    First Pass Resolve Rate 97.0% 15 96.7% 22
    Provider Collection Burden 23.5% 129 23.5% 109
    Denial Rate 7.1% 89 6.1% 64
    ERA Transparency 98.9% 34 98.8% 35
    Eligibility Accuracy 92.4% 145 92.9% 125
    Benefit Reliability 100.0% 1 98.0% 12
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #47 CoventryCares Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 31.3 days 106 32.4 days 100
    First Pass Resolve Rate 92.6% 126 90.6% 123
    Provider Collection Burden 2.5% 33 3.9% 35
    Denial Rate 8.9% 116 13.1% 128
    ERA Transparency 98.1% 62 98.0% 55
    Eligibility Accuracy 97.9% 52 89.7% 143
    Benefit Reliability 99.0% 41 90.2% 92
    Enrollment Efficiency 50.0% 159 50.0% 141
    Enrollment Turn Around Time - - - -
  • #48 Cigna West Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 29.7 days 96 34.9 days 112
    First Pass Resolve Rate 94.4% 99 92.6% 115
    Provider Collection Burden 20.8% 105 23.7% 112
    Denial Rate 5.9% 62 7.9% 100
    ERA Transparency 98.3% 51 96.4% 80
    Eligibility Accuracy 97.1% 76 91.5% 136
    Benefit Reliability 93.2% 97 56.7% 127
    Enrollment Efficiency 92.0% 9 74.0% 73
    Enrollment Turn Around Time 18 days 30 27 days 92
  • #49 BCBS-MI Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 23.4 days 33 24 days 46
    First Pass Resolve Rate 95.1% 83 93.7% 102
    Provider Collection Burden 16.9% 92 16.5% 80
    Denial Rate 7.0% 88 7.9% 100
    ERA Transparency 98.3% 51 98.5% 46
    Eligibility Accuracy 97.6% 60 98.1% 20
    Benefit Reliability 88.3% 109 87.5% 99
    Enrollment Efficiency 87.0% 33 87.0% 35
    Enrollment Turn Around Time 8 days 8 7 days 10
  • #50 Champus-Tricare PGBA Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 25.9 days 65 25 days 58
    First Pass Resolve Rate 95.5% 70 95.7% 59
    Provider Collection Burden 13.7% 79 12.0% 68
    Denial Rate 7.6% 93 6.7% 80
    ERA Transparency 98.5% 48 90.3% 119
    Eligibility Accuracy 98.0% 45 97.4% 40
    Benefit Reliability 89.2% 106 75.3% 115
    Enrollment Efficiency 70.0% 101 70.0% 81
    Enrollment Turn Around Time 13 days 17 27 days 92
  • #51 Fidelis Care NY Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 42.2 days 144 41.2 days 130
    First Pass Resolve Rate 94.1% 106 94.4% 89
    Provider Collection Burden 3.7% 41 2.8% 28
    Denial Rate 8.5% 111 10.5% 118
    ERA Transparency 99.2% 26 99.5% 16
    Eligibility Accuracy 97.5% 64 98.1% 20
    Benefit Reliability 94.8% 87 0 68
    Enrollment Efficiency 91.0% 24 91.0% 23
    Enrollment Turn Around Time 32 days 130 - -
  • #52 Keystone Health Plan East Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 34 days 118 33.4 days 104
    First Pass Resolve Rate 93.2% 115 68.4% 147
    Provider Collection Burden 4.2% 43 3.1% 31
    Denial Rate 8.4% 109 7.8% 95
    ERA Transparency 97.8% 68 95.8% 87
    Eligibility Accuracy 96.8% 84 96.7% 56
    Benefit Reliability 95.2% 68 89.4% 96
    Enrollment Efficiency 87.0% 33 87.0% 35
    Enrollment Turn Around Time 18 days 30 9 days 16
  • #53 UnitedHealthcare Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 28.5 days 86 26.3 days 76
    First Pass Resolve Rate 96.1% 40 96.6% 28
    Provider Collection Burden 16.6% 89 15.1% 76
    Denial Rate 4.9% 26 4.5% 24
    ERA Transparency 98.1% 62 97.7% 61
    Eligibility Accuracy 98.5% 24 98.8% 9
    Benefit Reliability 86.2% 119 85.4% 104
    Enrollment Efficiency 90.0% 32 90.0% 34
    Enrollment Turn Around Time 26 days 57 14 days 27
  • #54 BCBS-WA Premera Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 28 days 85 28.2 days 86
    First Pass Resolve Rate 96.0% 45 95.3% 73
    Provider Collection Burden 18.5% 96 16.6% 81
    Denial Rate 3.9% 9 3.1% 2
    ERA Transparency 94.1% 115 96.3% 83
    Eligibility Accuracy 97.2% 73 95.1% 90
    Benefit Reliability 92.5% 100 91.7% 88
    Enrollment Efficiency 87.0% 33 87.0% 35
    Enrollment Turn Around Time 25 days 54 - -
  • #55 Medicare B-TX Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 29 days 91 28.7 days 88
    First Pass Resolve Rate 96.0% 45 95.6% 64
    Provider Collection Burden 23.5% 129 23.8% 117
    Denial Rate 5.9% 62 6.2% 68
    ERA Transparency 96.2% 93 98.6% 42
    Eligibility Accuracy 94.8% 113 95.2% 87
    Benefit Reliability 100.0% 1 97.1% 38
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #56 BCBS-OH Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 22.4 days 24 22.4 days 30
    First Pass Resolve Rate 97.5% 5 96.7% 22
    Provider Collection Burden 15.9% 85 15.4% 77
    Denial Rate 4.9% 26 4.6% 26
    ERA Transparency 93.4% 119 95.2% 96
    Eligibility Accuracy 98.7% 14 97.6% 38
    Benefit Reliability 87.6% 112 83.4% 107
    Enrollment Efficiency 86.0% 39 92.0% 11
    Enrollment Turn Around Time 30 days 125 8 days 13
  • #57 Medicare B-Railroad Medicare Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 46.8 days 153 46.6 days 140
    First Pass Resolve Rate 95.8% 54 95.8% 53
    Provider Collection Burden 23.3% 127 23.7% 112
    Denial Rate 7.2% 90 5.0% 41
    ERA Transparency 100.0% 1 100.0% 1
    Eligibility Accuracy 94.7% 116 94.7% 98
    Benefit Reliability 100.0% 1 95.2% 57
    Enrollment Efficiency 79.0% 75 79.0% 63
    Enrollment Turn Around Time 22 days 42 26 days 89
  • #58 Medicare B-CA Southern Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 29.5 days 95 25.2 days 61
    First Pass Resolve Rate 94.8% 91 95.7% 59
    Provider Collection Burden 22.4% 115 23.3% 107
    Denial Rate 8.0% 101 7.6% 93
    ERA Transparency 99.8% 12 100.0% 1
    Eligibility Accuracy 93.6% 128 93.8% 117
    Benefit Reliability 100.0% 1 96.9% 42
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #59 BCBS-AZ Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 25.4 days 61 21.6 days 19
    First Pass Resolve Rate 94.3% 100 94.5% 87
    Provider Collection Burden 25.0% 152 23.6% 111
    Denial Rate 4.6% 20 4.8% 33
    ERA Transparency 98.8% 38 97.0% 71
    Eligibility Accuracy 95.7% 103 94.1% 110
    Benefit Reliability 95.0% 69 94.4% 63
    Enrollment Efficiency 56.0% 120 59.0% 99
    Enrollment Turn Around Time 33 days 134 28 days 97
  • #60 Medicare B-NJ Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 25.6 days 62 24.3 days 51
    First Pass Resolve Rate 95.7% 60 96.3% 41
    Provider Collection Burden 22.6% 117 22.3% 102
    Denial Rate 7.7% 94 6.8% 81
    ERA Transparency 98.0% 64 98.6% 42
    Eligibility Accuracy 92.5% 144 92.9% 125
    Benefit Reliability 100.0% 1 98.0% 12
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #61 Medicare B-NY Upstate Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 23.5 days 35 23.3 days 37
    First Pass Resolve Rate 96.6% 26 95.6% 64
    Provider Collection Burden 22.0% 111 22.4% 103
    Denial Rate 4.4% 19 6.5% 75
    ERA Transparency 96.0% 97 97.9% 57
    Eligibility Accuracy 89.7% 163 91.6% 135
    Benefit Reliability 100.0% 1 95.3% 55
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #62 BCBS-MN Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 22.5 days 25 - -
    First Pass Resolve Rate 95.7% 60 - -
    Provider Collection Burden 31.0% 166 - -
    Denial Rate 4.1% 11 - -
    ERA Transparency 97.7% 71 - -
    Eligibility Accuracy 90.2% 160 - -
    Benefit Reliability 97.8% 49 - -
    Enrollment Efficiency 80.0% 69 - -
    Enrollment Turn Around Time - - - -
  • #63 Medicare B-WV Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 25.6 days 62 27.1 days 82
    First Pass Resolve Rate 96.0% 45 95.1% 77
    Provider Collection Burden 27.1% 160 26.5% 143
    Denial Rate 6.9% 86 8.6% 106
    ERA Transparency 99.9% 7 99.9% 7
    Eligibility Accuracy 90.0% 161 90.0% 141
    Benefit Reliability 100.0% 1 97.8% 16
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #64 Medicare B-ME Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 26.2 days 69 21.7 days 21
    First Pass Resolve Rate 95.8% 54 96.7% 22
    Provider Collection Burden 24.5% 143 25.2% 137
    Denial Rate 5.9% 62 7.2% 88
    ERA Transparency 94.7% 111 99.1% 26
    Eligibility Accuracy 94.2% 122 94.7% 98
    Benefit Reliability 100.0% 1 98.2% 8
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #65 Medicare B-CO Medicare B/DME

    Metric 2014
    Score
    2014
    Rank
    2015
    Score
    2015
    Rank
    Days in A/R 26.5 days 71 25.4 days 66
    First Pass Resolve Rate 94.8% 91 96.4% 34
    Provider Collection Burden 24.8% 150 24.3% 122
    Denial Rate 8.8% 115 6.2% 68
    ERA Transparency 97.8% 68 96.4% 80
    Eligibility Accuracy 94.8% 113 95.2% 87
    Benefit Reliability 100.0% 1 97.3% 31
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #66 Medicare B-MD Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 29 days 91 33.7 days 106
    First Pass Resolve Rate 95.0% 85 93.7% 102
    Provider Collection Burden 23.1% 121 23.5% 109
    Denial Rate 7.9% 99 7.5% 92
    ERA Transparency 98.9% 34 99.5% 16
    Eligibility Accuracy 92.9% 142 94.0% 113
    Benefit Reliability 100.0% 1 97.3% 31
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #67 Medicare B-NM Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 29.2 days 94 25.1 days 59
    First Pass Resolve Rate 95.6% 66 95.2% 75
    Provider Collection Burden 25.9% 157 27.4% 146
    Denial Rate 10.1% 129 6.2% 68
    ERA Transparency 99.3% 24 98.9% 32
    Eligibility Accuracy 94.1% 123 94.9% 94
    Benefit Reliability 100.0% 1 97.1% 38
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #68 Medicare B-LA Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 29.8 days 98 25.8 days 74
    First Pass Resolve Rate 95.5% 70 96.4% 34
    Provider Collection Burden 24.8% 150 23.9% 120
    Denial Rate 6.8% 85 5.7% 55
    ERA Transparency 98.2% 56 98.5% 46
    Eligibility Accuracy 92.4% 145 93.0% 123
    Benefit Reliability 100.0% 1 97.5% 25
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #69 MVP Health Care of NY Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 26.8 days 74 27.7 days 83
    First Pass Resolve Rate 95.5% 70 95.6% 64
    Provider Collection Burden 9.9% 64 9.5% 58
    Denial Rate 5.2% 39 3.9% 14
    ERA Transparency 85.2% 150 91.7% 116
    Eligibility Accuracy 99.3% 3 98.5% 14
    Benefit Reliability 98.1% 48 93.3% 67
    Enrollment Efficiency 85.0% 46 67.0% 85
    Enrollment Turn Around Time - - - -
  • #70 BCBS-VA Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 23.6 days 38 23.9 days 44
    First Pass Resolve Rate 94.9% 87 96.2% 43
    Provider Collection Burden 13.7% 79 13.2% 72
    Denial Rate 5.9% 62 5.2% 45
    ERA Transparency 95.5% 106 93.4% 108
    Eligibility Accuracy 98.2% 38 97.6% 38
    Benefit Reliability 87% 114 90.1% 93
    Enrollment Efficiency 85.0% 46 91.0% 23
    Enrollment Turn Around Time 25 days 54 25 days 84
  • #71 Medicare B-NY Empire Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 27.7 days 82 24.7 days 54
    First Pass Resolve Rate 95.7% 60 96.5% 32
    Provider Collection Burden 22.6% 117 22.5% 104
    Denial Rate 7.4% 92 8.4% 104
    ERA Transparency 99.0% 33 99.7% 11
    Eligibility Accuracy 90.4% 158 91.8% 131
    Benefit Reliability 100.0% 1 97.5% 25
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #72 BCBS-IN Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 22.9 days 28 22.1 days 23
    First Pass Resolve Rate 96.0% 45 96.3% 41
    Provider Collection Burden 21.1% 107 21.2% 96
    Denial Rate 6.1% 75 6.8% 81
    ERA Transparency 95.6% 102 97.0% 71
    Eligibility Accuracy 98.4% 29 97.0% 51
    Benefit Reliability 88.0% 111 81.3% 109
    Enrollment Efficiency 86.0% 39 92.0% 11
    Enrollment Turn Around Time 39 days 153 - -
  • #73 BCBS-NJ Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 24.8 days 55 27.7 days 83
    First Pass Resolve Rate 94.1% 106 93.9% 99
    Provider Collection Burden 15.0% 84 15.0% 75
    Denial Rate 8.9% 116 10.4% 117
    ERA Transparency 97.5% 73 96.1% 85
    Eligibility Accuracy 95.8% 98 90.8% 139
    Benefit Reliability 94.3% 90 92.2% 84
    Enrollment Efficiency 71.0% 98 75.0% 72
    Enrollment Turn Around Time 28 days 65 29 days 104
  • #74 BCBS-MD Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 27 days 77 29.5 days 93
    First Pass Resolve Rate 94.9% 87 95.7% 59
    Provider Collection Burden 14.5% 82 14.6% 74
    Denial Rate 5.1% 34 5.8% 57
    ERA Transparency 96.0% 97 97.1% 69
    Eligibility Accuracy 94.9% 112 96.5% 62
    Benefit Reliability 92.4% 101 89.7% 94
    Enrollment Efficiency 67.0% 105 67.0% 85
    Enrollment Turn Around Time 23 days 46 10 days 18
  • #75 BCBS-KANSAS CITY Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 23 days 31 20.4 days 12
    First Pass Resolve Rate 97.0% 15 97.2% 12
    Provider Collection Burden 21.2% 108 20.4% 94
    Denial Rate 4.9% 26 4.4% 20
    ERA Transparency 95.6% 102 95.4% 93
    Eligibility Accuracy 97.0% 78 91.8% 131
    Benefit Reliability 84.9% 122 83.9% 105
    Enrollment Efficiency 85.0% 46 85.0% 43
    Enrollment Turn Around Time - - - -
  • #76 Select Health of SC Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 33.3 days 114 25.2 days 61
    First Pass Resolve Rate 92.4% 132 93.6% 104
    Provider Collection Burden 1.9% 22 2.0% 15
    Denial Rate 16.2% 152 13.2% 130
    ERA Transparency 94.5% 112 94.8% 100
    Eligibility Accuracy 98.8% 13 98.1% 20
    Benefit Reliability 99.1% 40 42.1% 128
    Enrollment Efficiency 91.0% 24 91.0% 23
    Enrollment Turn Around Time 8 days 8 26 days 89
  • #77 BCBS-OR Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 23.7 days 41 21.2 days 14
    First Pass Resolve Rate 96.1% 40 97.9% 2
    Provider Collection Burden 18.9% 98 18.9% 90
    Denial Rate 4.9% 26 2.9% 1
    ERA Transparency 90.4% 135 93.8% 106
    Eligibility Accuracy 96.9% 81 94.8% 95
    Benefit Reliability 91.6% 102 92.1% 87
    Enrollment Efficiency 84.0% 53 84.0% 44
    Enrollment Turn Around Time 17 days 27 18 days 33
  • #78 Medicaid-OH Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 32.5 days 111 34.2 days 108
    First Pass Resolve Rate 93.0% 118 89.0% 130
    Provider Collection Burden 4.9% 46 7.5% 46
    Denial Rate 13.7% 145 20.2% 141
    ERA Transparency 97.9% 66 95.7% 90
    Eligibility Accuracy 96.6% 86 95.5% 83
    Benefit Reliability - - 0 68
    Enrollment Efficiency 84.0% 53 84.0% 44
    Enrollment Turn Around Time 14 days 22 8 days 13
  • #79 BCBS-TN Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 22.9 days 28 21 days 13
    First Pass Resolve Rate 96.1% 40 95.5% 68
    Provider Collection Burden 19.9% 100 19.9% 93
    Denial Rate 5.7% 59 6.1% 64
    ERA Transparency 87.5% 142 92.5% 112
    Eligibility Accuracy 98.1% 41 96.5% 62
    Benefit Reliability 96.4% 60 96.7% 44
    Enrollment Efficiency 77.0% 83 49.0% 142
    Enrollment Turn Around Time 35 days 148 28 days 97
  • #80 BCBS-MI Blue Care Network Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 24.4 days 50 - -
    First Pass Resolve Rate 94.5% 96 - -
    Provider Collection Burden 9.1% 62 - -
    Denial Rate 9.7% 125 - -
    ERA Transparency 97.9% 66 - -
    Eligibility Accuracy 97.8% 55 - -
    Benefit Reliability 84.6% 124 - -
    Enrollment Efficiency 80.0% 69 - -
    Enrollment Turn Around Time 8 days 8 - -
  • #81 CDPHP (NY) Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 24.1 days 46 26.3 days 76
    First Pass Resolve Rate 95.2% 80 94.0% 97
    Provider Collection Burden 5.8% 50 5.4% 40
    Denial Rate 3.7% 7 5.5% 54
    ERA Transparency 97.7% 71 98.5% 46
    Eligibility Accuracy 99.0% 7 98.0% 24
    Benefit Reliability 78.6% 132 87.7% 98
    Enrollment Efficiency 59.0% 116 55.0% 102
    Enrollment Turn Around Time - - - -
  • #82 HealthChoice Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 27.8 days 83 - -
    First Pass Resolve Rate 97.2% 11 - -
    Provider Collection Burden 15.9% 85 - -
    Denial Rate 2.6% 1 - -
    ERA Transparency 87.7% 141 - -
    Eligibility Accuracy - - - -
    Benefit Reliability - - - -
    Enrollment Efficiency 43.0% 165 - -
    Enrollment Turn Around Time 13 days 17 - -
  • #83 BCBS-ME Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 23.3 days 32 - -
    First Pass Resolve Rate 95.3% 76 - -
    Provider Collection Burden 15.9% 85 - -
    Denial Rate 4.6% 20 - -
    ERA Transparency 85.2% 150 - -
    Eligibility Accuracy 98.7% 14 - -
    Benefit Reliability 96.1% 62 - -
    Enrollment Efficiency 78.0% 78 - -
    Enrollment Turn Around Time - - - -
  • #84 Medicare B-DC Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 27.3 days 81 - -
    First Pass Resolve Rate 92.8% 124 - -
    Provider Collection Burden 24.0% 135 - -
    Denial Rate 12.5% 144 - -
    ERA Transparency 99.6% 19 - -
    Eligibility Accuracy 95.2% 106 - -
    Benefit Reliability 100.0% 1 - -
    Enrollment Efficiency 55.0% 121 - -
    Enrollment Turn Around Time 29 days 70 - -
  • #85 BCBS-IL Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 21 days 6 23.3 days 37
    First Pass Resolve Rate 96.2% 39 95.9% 50
    Provider Collection Burden 25.9% 157 24.2% 121
    Denial Rate 6.0% 71 5.3% 48
    ERA Transparency 96.1% 94 95.8% 87
    Eligibility Accuracy 97.3% 70 97.7% 36
    Benefit Reliability 85.1% 120 86.8% 100
    Enrollment Efficiency 84.0% 53 76.0% 68
    Enrollment Turn Around Time 33 days 134 32 days 109
  • #86 Boston Medical Ctr-Health Net Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 23.9 days 42 22.1 days 23
    First Pass Resolve Rate 94.9% 87 95.4% 70
    Provider Collection Burden 0.4% 1 0.6% 1
    Denial Rate 5.2% 39 5.9% 60
    ERA Transparency 82.0% 157 86.9% 129
    Eligibility Accuracy 98.4% 29 97.8% 30
    Benefit Reliability 95.7% 63 95.4% 54
    Enrollment Efficiency 86.0% 39 86.0% 42
    Enrollment Turn Around Time 23 days 46 - -
  • #87 Medicare B-PA Medicare B/DME

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 32.6 days 112 25.2 days 61
    First Pass Resolve Rate 96.3% 34 96.7% 22
    Provider Collection Burden 23.2% 124 23.8% 117
    Denial Rate 5.7% 59 4.4% 20
    ERA Transparency 93.8% 118 98.2% 52
    Eligibility Accuracy 92.0% 148 93.0% 123
    Benefit Reliability 100.0% 1 97.5% 25
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 29 days 70 18 days 33
  • #88 BCBS-WV Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 22.7 days 26 20.1 days 9
    First Pass Resolve Rate 92.4% 132 94.0% 97
    Provider Collection Burden 23.2% 124 21.7% 98
    Denial Rate 9.0% 119 8.8% 111
    ERA Transparency 98.9% 34 97.8% 59
    Eligibility Accuracy 92.8% 143 91.0% 138
    Benefit Reliability 93.5% 95 93.7% 65
    Enrollment Efficiency 87.0% 33 87.0% 35
    Enrollment Turn Around Time 9 days 13 6 days 4
  • #89 BCBS-KY Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 21.9 days 15 22.1 days 23
    First Pass Resolve Rate 96.5% 29 94.3% 91
    Provider Collection Burden 20.7% 104 24.5% 126
    Denial Rate 8.1% 103 6.9% 85
    ERA Transparency 92.8% 122 96.4% 80
    Eligibility Accuracy 98.5% 24 96.1% 70
    Benefit Reliability 87.0% 114 81.3% 109
    Enrollment Efficiency 86.0% 39 92.0% 11
    Enrollment Turn Around Time - - - -
  • #90 UPMC Health Plan Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 24 days 45 24.4 days 52
    First Pass Resolve Rate 95.9% 50 95.9% 50
    Provider Collection Burden 7.0% 55 6.2% 44
    Denial Rate 5.4% 46 4.7% 31
    ERA Transparency 99.4% 23 99.5% 16
    Eligibility Accuracy 95.9% 97 95.8% 79
    Benefit Reliability 76.4% 134 70.4% 119
    Enrollment Efficiency 92.0% 9 92.0% 11
    Enrollment Turn Around Time 38 days 151 27 days 92
  • #91 UnitedHealthcare-Oxford Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 42.4 days 145 39.7 days 126
    First Pass Resolve Rate 95.2% 80 96.0% 46
    Provider Collection Burden 14.5% 82 13.3% 73
    Denial Rate 9.5% 123 7.8% 95
    ERA Transparency 93.3% 120 91.9% 113
    Eligibility Accuracy 98.9% 10 98.6% 13
    Benefit Reliability 94.3% 90 90.8% 89
    Enrollment Efficiency 92.0% 9 92.0% 11
    Enrollment Turn Around Time 33 days 134 23 days 79
  • #92 Magnolia Health Plan Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 41.1 days 143 - -
    First Pass Resolve Rate 89.6% 150 - -
    Provider Collection Burden 1.8% 19 - -
    Denial Rate 11.2% 135 - -
    ERA Transparency 98.2% 56 - -
    Eligibility Accuracy 98.1% 41 - -
    Benefit Reliability - - - -
    Enrollment Efficiency 92.0% 9 - -
    Enrollment Turn Around Time - - - -
  • #93 BCBS-MO Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 24.4 days 50 22.7 days 34
    First Pass Resolve Rate 96.7% 23 95.1% 77
    Provider Collection Burden 24.2% 138 24.3% 122
    Denial Rate 5.0% 33 5.4% 50
    ERA Transparency 96.1% 94 98.6% 42
    Eligibility Accuracy 98.2% 38 95.9% 75
    Benefit Reliability 80.3% 130 77.5% 114
    Enrollment Efficiency 86.0% 39 92.0% 11
    Enrollment Turn Around Time - - 27 days 92
  • #94 Priority Partners MCO Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 28.6 days 87 24.7 days 54
    First Pass Resolve Rate 95.3% 76 96.6% 28
    Provider Collection Burden 1.3% 8 1.3% 6
    Denial Rate 6.7% 80 3.7% 11
    ERA Transparency 98.7% 41 99.6% 15
    Eligibility Accuracy 86.0% 166 72.6% 147
    Benefit Reliability - - 0 68
    Enrollment Efficiency 49.0% 160 49.0% 142
    Enrollment Turn Around Time - - - -
  • #95 Neighborhood Health Plan Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 39.7 days 139 40.3 days 128
    First Pass Resolve Rate 95.3% 76 95.8% 53
    Provider Collection Burden 1.6% 16 1.4% 7
    Denial Rate 4.2% 15 5.0% 41
    ERA Transparency 84.0% 153 95.3% 95
    Eligibility Accuracy 99.6% 1 99.4% 2
    Benefit Reliability 97.1% 56 95.9% 49
    Enrollment Efficiency 85.0% 46 80.0% 58
    Enrollment Turn Around Time 63 days 161 - -
  • #96 Freedom Health Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 42.9 days 146 - -
    First Pass Resolve Rate 92.3% 134 - -
    Provider Collection Burden 1.2% 6 - -
    Denial Rate 5.6% 53 - -
    ERA Transparency 92.3% 125 - -
    Eligibility Accuracy - - - -
    Benefit Reliability - - - -
    Enrollment Efficiency 85.0% 46 - -
    Enrollment Turn Around Time - - - -
  • #97 Avmed Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 33.5 days 115 32.9 days 101
    First Pass Resolve Rate 95.9% 50 95.7% 59
    Provider Collection Burden 5.8% 50 7.1% 45
    Denial Rate 8.4% 109 5.8% 57
    ERA Transparency 99.7% 17 81.4% 134
    Eligibility Accuracy 98.0% 45 93.9% 115
    Benefit Reliability 76.4% 134 79.1% 113
    Enrollment Efficiency 92.0% 9 92.0% 11
    Enrollment Turn Around Time 24 days 51 44 days 122
  • #98 BCBS-MS Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 25.3 days 59 25.7 days 72
    First Pass Resolve Rate 92.3% 134 94.1% 95
    Provider Collection Burden 28.6% 162 28.0% 147
    Denial Rate 6.0% 71 5.9% 60
    ERA Transparency 88.7% 138 97.3% 65
    Eligibility Accuracy 98.3% 32 96.0% 72
    Benefit Reliability 98.5% 46 98.3% 5
    Enrollment Efficiency 66.0% 108 66.0% 88
    Enrollment Turn Around Time 10 days 14 8 days 13
  • #99 Medicaid-CT Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 22.9 days 28 25.3 days 65
    First Pass Resolve Rate 94.3% 100 93.2% 110
    Provider Collection Burden 1.4% 11 2.0% 15
    Denial Rate 16.2% 152 10.5% 118
    ERA Transparency 88.0% 140 60.7% 146
    Eligibility Accuracy 97.7% 56 97.8% 30
    Benefit Reliability - - 0 68
    Enrollment Efficiency 100.0% 1 100.0% 1
    Enrollment Turn Around Time 8 days 8 9 days 16
  • #100 Paramount Health Care Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 47 days 154 - -
    First Pass Resolve Rate 96.4% 31 - -
    Provider Collection Burden 3.4% 38 - -
    Denial Rate 7.3% 91 - -
    ERA Transparency 97.5% 73 - -
    Eligibility Accuracy 95.1% 108 - -
    Benefit Reliability 84.9% 122 - -
    Enrollment Efficiency 85.0% 46 - -
    Enrollment Turn Around Time 27 days 60 - -
  • #101 Health America-Hlth Assurance Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 30 days 100 25.6 days 71
    First Pass Resolve Rate 93.9% 109 94.8% 82
    Provider Collection Burden 5.9% 52 8.2% 52
    Denial Rate 8.6% 112 9.3% 113
    ERA Transparency 91.3% 132 95.6% 91
    Eligibility Accuracy 99.3% 3 98.5% 14
    Benefit Reliability 87.3% 113 86.3% 101
    Enrollment Efficiency 92.0% 9 92.0% 11
    Enrollment Turn Around Time 32 days 130 - -
  • #102 BCBS-OK Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 24.6 days 54 24.8 days 56
    First Pass Resolve Rate 95.8% 54 96.0% 46
    Provider Collection Burden 28.8% 163 26.9% 145
    Denial Rate 7.7% 94 10.6% 121
    ERA Transparency 98.3% 51 99.4% 22
    Eligibility Accuracy 98.1% 41 98.0% 24
    Benefit Reliability 81.7% 129 81.9% 108
    Enrollment Efficiency 76.0% 84 76.0% 68
    Enrollment Turn Around Time 33 days 134 27 days 92
  • #103 BCBS-CT Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 20.4 days 4 19.1 days 5
    First Pass Resolve Rate 96.8% 21 96.4% 34
    Provider Collection Burden 10.7% 67 9.3% 56
    Denial Rate 5.9% 62 5.0% 41
    ERA Transparency 80.5% 159 76.3% 141
    Eligibility Accuracy 98.0% 45 97.2% 46
    Benefit Reliability 94.0% 93 94.6% 61
    Enrollment Efficiency 78.0% 78 84.0% 44
    Enrollment Turn Around Time 28 days 65 16 days 29
  • #104 Coventry Healthcare of GA Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 25.2 days 57 25.5 days 69
    First Pass Resolve Rate 95.1% 83 94.3% 91
    Provider Collection Burden 25.1% 153 20.7% 95
    Denial Rate 10.2% 131 10.0% 115
    ERA Transparency 96.4% 92 96.8% 74
    Eligibility Accuracy 97.4% 67 94.7% 98
    Benefit Reliability 85.1% 120 80.9% 111
    Enrollment Efficiency 99.0% 2 99.0% 2
    Enrollment Turn Around Time 27 days 60 - -
  • #105 Champus-Tricare WPS Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 35 days 123 30.2 days 97
    First Pass Resolve Rate 94.0% 108 94.3% 91
    Provider Collection Burden 11.7% 70 11.2% 64
    Denial Rate 8.6% 112 7.2% 88
    ERA Transparency 96.1% 94 87.8% 128
    Eligibility Accuracy 96.6% 86 95.9% 75
    Benefit Reliability 87.0% 114 66.1% 125
    Enrollment Efficiency 78.0% 78 77.0% 66
    Enrollment Turn Around Time 15 days 23 18 days 33
  • #106 BCBS-CO Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 21.1 days 8 19.7 days 6
    First Pass Resolve Rate 95.7% 60 95.8% 53
    Provider Collection Burden 19.9% 100 18.8% 89
    Denial Rate 6.7% 80 6.5% 75
    ERA Transparency 91.0% 133 92.6% 111
    Eligibility Accuracy 97.9% 52 96.6% 59
    Benefit Reliability 82.4% 128 83.5% 106
    Enrollment Efficiency 86.0% 39 84.0% 44
    Enrollment Turn Around Time 34 days 147 24 days 81
  • #107 Coventry Healthcare of FL Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 31.3 days 106 31.8 days 99
    First Pass Resolve Rate 92.9% 122 92.9% 113
    Provider Collection Burden 8.9% 58 8.1% 51
    Denial Rate 16.1% 150 19.3% 140
    ERA Transparency 97.5% 73 97.3% 65
    Eligibility Accuracy 98.2% 38 91.8% 131
    Benefit Reliability 86.7% 117 86.0% 103
    Enrollment Efficiency 91.0% 24 91.0% 23
    Enrollment Turn Around Time 22 days 42 - -
  • #108 BCBS-PA Independence BC Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 34.5 days 121 33.6 days 105
    First Pass Resolve Rate 83.5% 163 76.6% 146
    Provider Collection Burden 12.6% 77 10.7% 62
    Denial Rate 6.4% 78 5.7% 55
    ERA Transparency 97.8% 68 94.2% 104
    Eligibility Accuracy 95.8% 98 96.2% 68
    Benefit Reliability 96.5% 59 94.8% 60
    Enrollment Efficiency 87.0% 33 87.0% 35
    Enrollment Turn Around Time 18 days 30 6 days 4
  • #109 Medicaid-IL Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 45.5 days 149 47.3 days 141
    First Pass Resolve Rate 93.4% 113 93.5% 105
    Provider Collection Burden 3.8% 42 2.6% 25
    Denial Rate 11.8% 141 9.1% 112
    ERA Transparency 98.2% 56 98.0% 55
    Eligibility Accuracy 98.7% 14 98.7% 12
    Benefit Reliability 84.6% 124 2.6% 139
    Enrollment Efficiency 72.0% 93 68.0% 83
    Enrollment Turn Around Time 21 days 38 25 days 84
  • #110 BCBS-RI Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 20.5 days 5 18.8 days 4
    First Pass Resolve Rate 97.3% 8 96.2% 43
    Provider Collection Burden 9.0% 60 7.7% 48
    Denial Rate 3.5% 5 3.2% 4
    ERA Transparency 78.1% 163 69.1% 144
    Eligibility Accuracy 98.7% 14 99.0% 6
    Benefit Reliability 88.4% 108 89.5% 95
    Enrollment Efficiency 58.0% 119 58.0% 101
    Enrollment Turn Around Time 15 days 23 18 days 33
  • #111 Medica Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 21.8 days 13 28.8 days 90
    First Pass Resolve Rate 94.6% 95 93.3% 108
    Provider Collection Burden 16.2% 88 18.1% 85
    Denial Rate 6.7% 80 6.8% 81
    ERA Transparency 86.8% 144 85.9% 132
    Eligibility Accuracy 98.7% 14 99.1% 4
    Benefit Reliability 86.7% 117 86.2% 102
    Enrollment Efficiency 59.0% 116 59.0% 99
    Enrollment Turn Around Time 13 days 17 - -
  • #112 BCBS-NY Empire Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 34.2 days 119 38.3 days 121
    First Pass Resolve Rate 93.0% 118 94.3% 91
    Provider Collection Burden 18.9% 98 17.0% 82
    Denial Rate 11.2% 135 11.8% 126
    ERA Transparency 96.9% 87 95.8% 87
    Eligibility Accuracy 97.6% 60 97.3% 44
    Benefit Reliability 88.3% 109 92.2% 84
    Enrollment Efficiency 62.0% 113 61.0% 95
    Enrollment Turn Around Time 26 days 57 21 days 73
  • #113 BCBS-NM Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 21.9 days 15 19.8 days 7
    First Pass Resolve Rate 96.4% 31 96.4% 34
    Provider Collection Burden 22.1% 112 26.5% 143
    Denial Rate 5.5% 48 6.5% 75
    ERA Transparency 94% 116 97.5% 62
    Eligibility Accuracy 96.4% 88 97.4% 40
    Benefit Reliability 75.4% 137 74.0% 117
    Enrollment Efficiency 83.0% 63 83.0% 54
    Enrollment Turn Around Time - - - -
  • #114 BCBS-GA Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 26.1 days 67 25.2 days 61
    First Pass Resolve Rate 96.5% 29 95.7% 59
    Provider Collection Burden 17.7% 94 18.6% 88
    Denial Rate 4.9% 26 5.9% 60
    ERA Transparency 79.0% 161 88.2% 127
    Eligibility Accuracy 98.7% 14 97.2% 46
    Benefit Reliability 90.9% 103 94.5% 62
    Enrollment Efficiency 86.0% 39 91.0% 23
    Enrollment Turn Around Time 33 days 134 33 days 111
  • #115 Blue Cross-CA Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 32.9 days 113 30 days 95
    First Pass Resolve Rate 93.2% 115 94.5% 87
    Provider Collection Burden 21.3% 109 21.2% 96
    Denial Rate 9.7% 125 7.8% 95
    ERA Transparency 91.9% 129 95.4% 93
    Eligibility Accuracy 96.9% 81 97.0% 51
    Benefit Reliability 90.7% 105 88.1% 97
    Enrollment Efficiency 78.0% 78 77.0% 66
    Enrollment Turn Around Time 30 days 125 33 days 111
  • #116 Medicaid-VA Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 40 days 140 38.3 days 121
    First Pass Resolve Rate 91.3% 140 90.2% 125
    Provider Collection Burden 11.8% 71 11.0% 63
    Denial Rate 17.8% 156 20.8% 142
    ERA Transparency 96.5% 91 99.7% 11
    Eligibility Accuracy 95.0% 110 94.8% 95
    Benefit Reliability 97.0% 57 69.1% 120
    Enrollment Efficiency 83.0% 63 83.0% 54
    Enrollment Turn Around Time 26 days 57 18 days 33
  • #117 Mercy Care Plan of Arizona Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 32.3 days 110 29.9 days 94
    First Pass Resolve Rate 92.2% 136 95.0% 80
    Provider Collection Burden 5.3% 47 5.5% 41
    Denial Rate 9.9% 127 6.2% 68
    ERA Transparency 89.8% 136 89.4% 122
    Eligibility Accuracy 98.9% 10 96.8% 54
    Benefit Reliability 88.7% 107 0 140
    Enrollment Efficiency 68.0% 103 64.0% 92
    Enrollment Turn Around Time 52 days 159 31 days 108
  • #118 Blue Shield-CA Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 31.9 days 108 29.4 days 92
    First Pass Resolve Rate 93.5% 112 94.4% 89
    Provider Collection Burden 23.1% 121 21.7% 98
    Denial Rate 11.2% 135 8.1% 103
    ERA Transparency 92.1% 127 89.4% 122
    Eligibility Accuracy 93.6% 128 95.8% 79
    Benefit Reliability 92.8% 99 92.2% 84
    Enrollment Efficiency 63.0% 112 63.0% 93
    Enrollment Turn Around Time 13 days 17 12 days 22
  • #119 Central California Alliance Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 37.8 days 133 36.6 days 115
    First Pass Resolve Rate 90.7% 143 92.3% 116
    Provider Collection Burden 9.6% 63 7.5% 46
    Denial Rate 9.3% 121 15.2% 134
    ERA Transparency 86.6% 146 92.9% 109
    Eligibility Accuracy 97.4% 67 94.7% 98
    Benefit Reliability - - 0 68
    Enrollment Efficiency 84.0% 53 84.0% 44
    Enrollment Turn Around Time - - - -
  • #120 MDwise Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 34.9 days 122 - -
    First Pass Resolve Rate 87.8% 152 - -
    Provider Collection Burden 2.3% 26 - -
    Denial Rate 14.3% 146 - -
    ERA Transparency 98.2% 56 - -
    Eligibility Accuracy 91.0% 156 - -
    Benefit Reliability - - - -
    Enrollment Efficiency 84.0% 53 - -
    Enrollment Turn Around Time 33 days 134 - -
  • #121 Medical Mutual Of Ohio Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 25.7 days 64 24 days 46
    First Pass Resolve Rate 97.2% 11 97.1% 14
    Provider Collection Burden 20.2% 102 19.6% 91
    Denial Rate 4.1% 11 4.4% 20
    ERA Transparency 91.5% 131 94.0% 105
    Eligibility Accuracy 97.2% 73 97.7% 36
    Benefit Reliability 69.0% 142 69.1% 120
    Enrollment Efficiency 70.0% 101 84.0% 44
    Enrollment Turn Around Time 18 days 30 22 days 77
  • #122 CHC of The Carolinas-Wellpath Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 21.7 days 11 - -
    First Pass Resolve Rate 92.7% 125 - -
    Provider Collection Burden 23.8% 133 - -
    Denial Rate 20.1% 158 - -
    ERA Transparency 99.7% 17 - -
    Eligibility Accuracy 98.4% 29 - -
    Benefit Reliability 78.7% 131 - -
    Enrollment Efficiency 99.0% 2 - -
    Enrollment Turn Around Time 29 days 70 - -
  • #123 Medicaid-LA Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 35.4 days 125 33.2 days 103
    First Pass Resolve Rate 86.2% 155 90.6% 123
    Provider Collection Burden 1.1% 4 1.2% 4
    Denial Rate 18.0% 157 10.7% 122
    ERA Transparency 95.2% 109 99.1% 26
    Eligibility Accuracy 98.5% 24 97.2% 46
    Benefit Reliability - - 0 68
    Enrollment Efficiency 47.0% 161 47.0% 144
    Enrollment Turn Around Time 28 days 65 25 days 84
  • #124 Medicaid-AR Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 39.1 days 136 34.8 days 111
    First Pass Resolve Rate 86.8% 153 87.0% 134
    Provider Collection Burden 5.4% 48 7.7% 48
    Denial Rate 6.9% 86 5.4% 50
    ERA Transparency 86.7% 145 89.3% 124
    Eligibility Accuracy 98.3% 32 94.7% 98
    Benefit Reliability 94.1% 92 95.8% 50
    Enrollment Efficiency 68.0% 103 68.0% 83
    Enrollment Turn Around Time - - 29 days 104
  • #125 BCBS-AL Blue

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 26.5 days 71 20.2 days 11
    First Pass Resolve Rate 93.0% 118 93.5% 105
    Provider Collection Burden 12.5% 76 11.6% 66
    Denial Rate 5.9% 62 6.6% 78
    ERA Transparency 95.2% 109 95.9% 86
    Eligibility Accuracy 97.7% 56 97.8% 30
    Benefit Reliability 69.3% 141 68.5% 122
    Enrollment Efficiency 47.0% 161 47.0% 144
    Enrollment Turn Around Time 7 days 4 10 days 18
  • #126 United Medical Resources Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 45.2 days 148 - -
    First Pass Resolve Rate 94.7% 93 - -
    Provider Collection Burden 25.1% 153 - -
    Denial Rate 8.9% 116 - -
    ERA Transparency 97.4% 77 - -
    Eligibility Accuracy 98.0% 45 - -
    Benefit Reliability 76.2% 136 - -
    Enrollment Efficiency 75.0% 89 - -
    Enrollment Turn Around Time - - - -
  • #127 Molina Healthcare of Ohio Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 37.7 days 131 38 days 120
    First Pass Resolve Rate 94.2% 103 93.8% 100
    Provider Collection Burden 1.6% 16 1.6% 10
    Denial Rate 8.2% 106 11.9% 127
    ERA Transparency 74.5% 165 67.3% 145
    Eligibility Accuracy 97.6% 60 96.0% 72
    Benefit Reliability - - 0 68
    Enrollment Efficiency 92.0% 9 92.0% 11
    Enrollment Turn Around Time 49 days 158 24 days 81
  • #128 Medicaid-MS Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 45.8 days 150 43 days 136
    First Pass Resolve Rate 89.9% 149 88.2% 133
    Provider Collection Burden 2.0% 24 1.0% 2
    Denial Rate 27.1% 164 8.7% 108
    ERA Transparency 96.9% 87 96.5% 77
    Eligibility Accuracy 97.0% 78 98.2% 19
    Benefit Reliability - - 95.8% 50
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 28 days 65 16 days 29
  • #129 Meritain Health Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 49.2 days 160 - -
    First Pass Resolve Rate 92.6% 126 - -
    Provider Collection Burden 23.4% 128 - -
    Denial Rate 7.9% 99 - -
    ERA Transparency 81.0% 158 - -
    Eligibility Accuracy 97.3% 70 - -
    Benefit Reliability - - - -
    Enrollment Efficiency 67.0% 105 - -
    Enrollment Turn Around Time - - - -
  • #130 Medicaid-IN Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 29.9 days 99 - -
    First Pass Resolve Rate 90.8% 142 - -
    Provider Collection Burden 8.1% 56 - -
    Denial Rate 17.1% 155 - -
    ERA Transparency 84.0% 153 - -
    Eligibility Accuracy 93.3% 135 - -
    Benefit Reliability - - - -
    Enrollment Efficiency 76.0% 84 - -
    Enrollment Turn Around Time 25 days 54 - -
  • #131 Medicaid-WV Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 48.7 days 159 41.3 days 131
    First Pass Resolve Rate 91.9% 139 90.9% 121
    Provider Collection Burden 2.4% 30 4.5% 36
    Denial Rate 11.3% 138 14.6% 132
    ERA Transparency 95.6% 102 85.1% 133
    Eligibility Accuracy 96.2% 92 94.8% 95
    Benefit Reliability 74.8% 138 0 68
    Enrollment Efficiency 72.0% 93 72.0% 75
    Enrollment Turn Around Time 47 days 157 16 days 29
  • #132 Medicaid-MA Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 63.5 days 164 53 days 145
    First Pass Resolve Rate 90.6% 144 89.5% 128
    Provider Collection Burden 6.5% 54 8.4% 54
    Denial Rate 25.2% 162 19.2% 139
    ERA Transparency 96.6% 90 90.8% 118
    Eligibility Accuracy 96.8% 84 96.5% 62
    Benefit Reliability - - 0 68
    Enrollment Efficiency 55.0% 121 55.0% 102
    Enrollment Turn Around Time 17 days 27 12 days 22
  • #133 Geisinger Health Plan Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 38.6 days 135 - -
    First Pass Resolve Rate 92.6% 126 - -
    Provider Collection Burden 10.9% 68 - -
    Denial Rate 7.7% 94 - -
    ERA Transparency 88.2% 139 - -
    Eligibility Accuracy 98.7% 14 - -
    Benefit Reliability 72.8% 139 - -
    Enrollment Efficiency 71.0% 98 - -
    Enrollment Turn Around Time 38 days 151 - -
  • #134 GEHA Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 55.5 days 162 - -
    First Pass Resolve Rate 84.1% 161 - -
    Provider Collection Burden 22.1% 112 - -
    Denial Rate 9.5% 123 - -
    ERA Transparency 97.0% 84 - -
    Eligibility Accuracy 91.3% 154 - -
    Benefit Reliability 93.1% 98 - -
    Enrollment Efficiency 92.0% 9 - -
    Enrollment Turn Around Time 33 days 134 - -
  • #135 Medicaid-TX Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 52.3 days 161 47.6 days 142
    First Pass Resolve Rate 81.2% 166 79.8% 143
    Provider Collection Burden 1.8% 19 1.8% 13
    Denial Rate 20.8% 159 21.5% 143
    ERA Transparency 97.0% 84 93.8% 106
    Eligibility Accuracy 98.0% 45 97.8% 30
    Benefit Reliability - - 0 68
    Enrollment Efficiency 72.0% 93 72.0% 75
    Enrollment Turn Around Time 21 days 38 28 days 97
  • #136 Medicaid-ME Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 25.2 days 57 - -
    First Pass Resolve Rate 92.6% 126 - -
    Provider Collection Burden 1.5% 14 - -
    Denial Rate 8.0% 101 - -
    ERA Transparency 89.3% 137 - -
    Eligibility Accuracy 96.1% 93 - -
    Benefit Reliability 56.9% 148 - -
    Enrollment Efficiency 79.0% 75 - -
    Enrollment Turn Around Time 13 days 17 - -
  • #137 Medicaid-FL Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 45.9 days 151 35.3 days 113
    First Pass Resolve Rate 85.6% 157 89.8% 126
    Provider Collection Burden 3.2% 37 2.8% 28
    Denial Rate 23.7% 161 17.6% 136
    ERA Transparency 99.2% 26 97.2% 67
    Eligibility Accuracy 93.5% 133 96.6% 59
    Benefit Reliability 83.8% 126 27.2% 133
    Enrollment Efficiency 65.0% 111 61.0% 95
    Enrollment Turn Around Time 19 days 34 16 days 29
  • #138 Medicaid-NY Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 104.4 days 166 81.7 days 147
    First Pass Resolve Rate 83.4% 164 86.0% 136
    Provider Collection Burden 2.2% 25 1.0% 2
    Denial Rate 14.7% 148 8.7% 108
    ERA Transparency 97.4% 77 94.3% 103
    Eligibility Accuracy 97.0% 78 91.9% 129
    Benefit Reliability 98.9% 43 34.5% 130
    Enrollment Efficiency 35.0% 166 35.0% 148
    Enrollment Turn Around Time 16 days 25 21 days 73
  • #139 Medicaid-GA Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 55.5 days 162 48.4 days 143
    First Pass Resolve Rate 83.4% 164 85.1% 139
    Provider Collection Burden 1.3% 8 1.4% 7
    Denial Rate 34.5% 166 35.6% 147
    ERA Transparency 94.5% 112 94.9% 97
    Eligibility Accuracy 94.6% 119 91.7% 134
    Benefit Reliability 99.0% 41 33.5% 131
    Enrollment Efficiency 71.0% 98 71.0% 80
    Enrollment Turn Around Time 4 days 1 4 days 1
  • #140 Health Net-AZ Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 35 days 123 37.1 days 118
    First Pass Resolve Rate 93.2% 115 92.0% 117
    Provider Collection Burden 12.0% 73 12.5% 70
    Denial Rate 7.8% 97 8.0% 102
    ERA Transparency 83.0% 156 79.1% 139
    Eligibility Accuracy 93.8% 125 95.0% 93
    Benefit Reliability 66.8% 143 66.2% 124
    Enrollment Efficiency 83.0% 63 91.0% 23
    Enrollment Turn Around Time 27 days 60 30 days 107
  • #141 Healthfirst NY & NJ Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 47.7 days 156 43.4 days 137
    First Pass Resolve Rate 90.3% 148 94.1% 95
    Provider Collection Burden 1.8% 19 2.9% 30
    Denial Rate 11.9% 142 9.9% 114
    ERA Transparency 77.8% 164 60.1% 147
    Eligibility Accuracy 94.8% 113 96.6% 59
    Benefit Reliability 82.5% 127 72.8% 118
    Enrollment Efficiency 83.0% 63 84.0% 44
    Enrollment Turn Around Time 23 days 46 - -
  • #142 Healthspring-TN Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 40.2 days 142 34.2 days 108
    First Pass Resolve Rate 95.2% 80 94.6% 84
    Provider Collection Burden 2.6% 34 5.5% 41
    Denial Rate 5.2% 39 7.8% 95
    ERA Transparency 95.6% 102 73.7% 142
    Eligibility Accuracy 98.1% 41 93.9% 115
    Benefit Reliability 36.1% 152 26.4% 134
    Enrollment Efficiency 80.0% 69 62.0% 94
    Enrollment Turn Around Time 7 days 4 7 days 10
  • #143 Group Health Inc (GHI) Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 35.5 days 126 35.7 days 114
    First Pass Resolve Rate 92.0% 137 93.0% 111
    Provider Collection Burden 23.2% 124 21.7% 98
    Denial Rate 8.3% 107 8.6% 106
    ERA Transparency 92.6% 124 86.9% 129
    Eligibility Accuracy 94.3% 121 96.5% 62
    Benefit Reliability 57.7% 147 65.5% 126
    Enrollment Efficiency 74.0% 90 74.0% 73
    Enrollment Turn Around Time 33 days 134 36 days 117
  • #144 UnitedHealthcare Community Plan Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 37.7 days 131 36.9 days 116
    First Pass Resolve Rate 91.2% 141 89.0% 130
    Provider Collection Burden 4.6% 44 4.8% 39
    Denial Rate 12.0% 143 11.2% 123
    ERA Transparency 95.4% 107 97.2% 67
    Eligibility Accuracy 96.1% 93 95.5% 83
    Benefit Reliability 50.8% 150 90.4% 90
    Enrollment Efficiency 91.0% 24 91.0% 23
    Enrollment Turn Around Time 37 days 150 33 days 111
  • #145 Wellcare Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 37.5 days 129 39.9 days 127
    First Pass Resolve Rate 92.5% 131 90.8% 122
    Provider Collection Burden 2.4% 30 2.2% 20
    Denial Rate 11.7% 140 8.7% 108
    ERA Transparency 79.8% 160 98.3% 50
    Eligibility Accuracy 97.5% 64 94.6% 105
    Benefit Reliability 65.9% 144 33.2% 132
    Enrollment Efficiency 87.0% 33 87.0% 35
    Enrollment Turn Around Time 53 days 160 57 days 127
  • #146 USFHP Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 30 days 100 34.7 days 110
    First Pass Resolve Rate 90.6% 144 93.8% 100
    Provider Collection Burden 1.3% 8 2.0% 15
    Denial Rate 5.5% 48 3.5% 7
    ERA Transparency 79.0% 161 94.9% 97
    Eligibility Accuracy 95.8% 98 95.1% 90
    Benefit Reliability 60.8% 146 66.5% 123
    Enrollment Efficiency 61.0% 114 61.0% 95
    Enrollment Turn Around Time 12 days 15 13 days 25
  • #147 Medicaid-CO Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 39.6 days 138 36.9 days 116
    First Pass Resolve Rate 93.0% 118 88.9% 132
    Provider Collection Burden 1.1% 4 1.5% 9
    Denial Rate 10.7% 133 10.5% 118
    ERA Transparency 70.3% 166 80.2% 136
    Eligibility Accuracy 96.4% 88 96.2% 68
    Benefit Reliability 77.7% 133 8.5% 137
    Enrollment Efficiency 47.0% 161 47.0% 144
    Enrollment Turn Around Time 23 days 46 20 days 72
  • #148 Health Net-CA-OR Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 47.6 days 155 45.3 days 139
    First Pass Resolve Rate 89.5% 151 91.0% 120
    Provider Collection Burden 12.1% 74 17.4% 84
    Denial Rate 8.7% 114 8.5% 105
    ERA Transparency 85.7% 149 89.5% 120
    Eligibility Accuracy 92.0% 148 94.7% 98
    Benefit Reliability 65.5% 145 80.5% 112
    Enrollment Efficiency 91.0% 24 91.0% 23
    Enrollment Turn Around Time 30 days 125 29 days 104
  • #149 Medi-Cal CA Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 68.6 days 165 61.6 days 146
    First Pass Resolve Rate 85.7% 156 82.3% 142
    Provider Collection Burden 2.3% 26 2.4% 23
    Denial Rate 16.3% 154 13.1% 128
    ERA Transparency 84.5% 152 42.5% 148
    Eligibility Accuracy 92.0% 148 92.8% 127
    Benefit Reliability - - 0 68
    Enrollment Efficiency 47.0% 161 47.0% 144
    Enrollment Turn Around Time 102 days 164 33 days 111
  • #150 Medicaid-NC Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 36.8 days 127 39.1 days 124
    First Pass Resolve Rate 83.7% 162 78.5% 144
    Provider Collection Burden 1.4% 11 2.0% 15
    Denial Rate 25.5% 163 30.6% 145
    ERA Transparency 95.3% 108 78.5% 140
    Eligibility Accuracy 92.2% 147 96.3% 67
    Benefit Reliability 70.0% 140 10.2% 135
    Enrollment Efficiency 73.0% 91 87.0% 35
    Enrollment Turn Around Time 7 days 4 6 days 4
  • #151 HIP of Greater NY Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 40.1 days 141 - -
    First Pass Resolve Rate 84.7% 159 - -
    Provider Collection Burden 8.6% 57 - -
    Denial Rate 14.6% 147 - -
    ERA Transparency 99.9% 7 - -
    Eligibility Accuracy 89.4% 165 - -
    Benefit Reliability 54.8% 149 - -
    Enrollment Efficiency 66.0% 108 - -
    Enrollment Turn Around Time 33 days 134 - -
  • #152 Medicaid-AL Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 38.3 days 134 41.8 days 133
    First Pass Resolve Rate 85.2% 158 85.2% 138
    Provider Collection Burden 2.3% 26 2.6% 25
    Denial Rate 15.7% 149 15.1% 133
    ERA Transparency 92.1% 127 88.6% 125
    Eligibility Accuracy 98.6% 22 98.9% 8
    Benefit Reliability 47.0% 151 9.8% 136
    Enrollment Efficiency 76.0% 84 76.0% 68
    Enrollment Turn Around Time 32 days 130 22 days 77
  • #153 Connecticare Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 21.8 days 13 25.4 days 66
    First Pass Resolve Rate 95.9% 50 96.4% 34
    Provider Collection Burden 11.9% 72 10.4% 59
    Denial Rate 5.1% 34 5.3% 48
    ERA Transparency 87.2% 143 88.5% 126
    Eligibility Accuracy 95.8% 98 98.1% 20
    Benefit Reliability 19.4% 153 36.4% 129
    Enrollment Efficiency 91.0% 24 91.0% 23
    Enrollment Turn Around Time 35 days 148 - -
  • #154 Providence Health Plan Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 28.9 days 89 29.3 days 91
    First Pass Resolve Rate 96.1% 40 96.0% 46
    Provider Collection Burden 20.3% 103 19.7% 92
    Denial Rate 3.4% 4 3.7% 11
    ERA Transparency 98.6% 45 91.9% 113
    Eligibility Accuracy 98.5% 24 96.8% 54
    Benefit Reliability 0 158 0 140
    Enrollment Efficiency 91.0% 24 91.0% 23
    Enrollment Turn Around Time 29 days 70 25 days 84
  • #155 Molina Healthcare of NM Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 30.3 days 102 - -
    First Pass Resolve Rate 93.9% 109 - -
    Provider Collection Burden 1.4% 11 - -
    Denial Rate 9.9% 127 - -
    ERA Transparency 98.3% 51 - -
    Eligibility Accuracy 96.3% 91 - -
    Benefit Reliability 7.7% 155 - -
    Enrollment Efficiency 99.0% 2 - -
    Enrollment Turn Around Time - - - -
  • #156 Amerigroup-GA Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 32 days 109 33.7 days 106
    First Pass Resolve Rate 93.3% 114 91.7% 118
    Provider Collection Burden 1.5% 14 2.3% 21
    Denial Rate 9.1% 120 18.3% 137
    ERA Transparency 98.2% 56 99.3% 24
    Eligibility Accuracy 97.3% 70 96.4% 66
    Benefit Reliability 0 158 0 140
    Enrollment Efficiency 92.0% 9 92.0% 11
    Enrollment Turn Around Time 44 days 155 42 days 120
  • #157 Amerigroup-TX Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 33.9 days 117 28.7 days 88
    First Pass Resolve Rate 92.0% 137 91.3% 119
    Provider Collection Burden 1.9% 22 1.6% 10
    Denial Rate 10.1% 129 11.6% 125
    ERA Transparency 99.5% 22 99.5% 16
    Eligibility Accuracy 97.5% 64 97.1% 49
    Benefit Reliability 0 158 0 140
    Enrollment Efficiency 72.0% 93 72.0% 75
    Enrollment Turn Around Time 21 days 38 28 days 97
  • #158 Virginia Premier Health Plan Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 43.1 days 147 45.2 days 138
    First Pass Resolve Rate 90.4% 146 89.7% 127
    Provider Collection Burden 2.7% 36 3.6% 33
    Denial Rate 11.4% 139 10.3% 116
    ERA Transparency 99.2% 26 99.5% 16
    Eligibility Accuracy 96.9% 81 95.9% 75
    Benefit Reliability 0 158 0 68
    Enrollment Efficiency 76.0% 84 69.0% 82
    Enrollment Turn Around Time 17 days 27 28 days 97
  • #159 Buckeye Community Health Plan Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 37.5 days 129 38.3 days 121
    First Pass Resolve Rate 92.9% 122 89.5% 128
    Provider Collection Burden 2.6% 34 2.0% 15
    Denial Rate 9.3% 121 7.3% 90
    ERA Transparency 93.3% 120 80.1% 137
    Eligibility Accuracy 98.0% 45 96.7% 56
    Benefit Reliability 0 158 0 68
    Enrollment Efficiency 92.0% 9 99.0% 2
    Enrollment Turn Around Time 76 days 163 49 days 124
  • #160 Caresource Medicaid

    Metric 2015
    Rank
    2015
    Score
    2014
    Rank
    2014
    Score
    Days in A/R 39.5 days 137 40.5 days 129
    First Pass Resolve Rate 93.9% 109 95.4% 70
    Provider Collection Burden 2.3% 26 1.7% 12
    Denial Rate 11.1% 134 11.3% 124
    ERA Transparency 98.2% 56 99.0% 29
    Eligibility Accuracy 90.8% 157 96.9% 53
    Benefit Reliability 0 158 0 68
    Enrollment Efficiency 91.0% 24 91.0% 23
    Enrollment Turn Around Time 39 days 153 32 days 109
  • #161 Horizon NJ Health Commercial

    Metric 2014
    Score
    2014
    Rank
    2015
    Score
    2015
    Rank
    Days in A/R 37.1 days 128 49.1 days 144
    First Pass Resolve Rate 92.6% 126 85.1% 139
    Provider Collection Burden 1.6% 16 2.3% 21
    Denial Rate 27.8% 165 30.3% 144
    ERA Transparency 99.6% 19 97.1% 69
    Eligibility Accuracy 90.3% 159 83.6% 146
    Benefit Reliability 13.6% 154 0 68
    Enrollment Efficiency 99.0% 2 99.0% 2
    Enrollment Turn Around Time 33 days 134 - -
  • #162 Fallon Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 47.7 days 156 41.4 days 132
    First Pass Resolve Rate 94.2% 103 95.8% 53
    Provider Collection Burden 5.4% 48 4.7% 38
    Denial Rate 5.2% 39 4.1% 16
    ERA Transparency 86.0% 147 79.4% 138
    Eligibility Accuracy 98.3% 32 98.4% 16
    Benefit Reliability 0 158 0 140
    Enrollment Efficiency 84.0% 53 65.0% 91
    Enrollment Turn Around Time 33 days 134 15 days 28
  • #163 Amerigroup-NJ Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 34.3 days 120 41.9 days 134
    First Pass Resolve Rate 90.4% 146 83.3% 141
    Provider Collection Burden 3.6% 40 3.2% 32
    Denial Rate 10.4% 132 15.3% 135
    ERA Transparency 98.3% 51 99.7% 11
    Eligibility Accuracy 90.0% 161 89.9% 142
    Benefit Reliability 0 158 0 140
    Enrollment Efficiency 92.0% 9 92.0% 11
    Enrollment Turn Around Time 44 days 155 42 days 120
  • #164 UnitedHealthcare of the River Valley Commercial

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 28.9 days 89 30.1 days 96
    First Pass Resolve Rate 94.2% 103 93.0% 111
    Provider Collection Burden 21.0% 106 10.4% 59
    Denial Rate 6.6% 79 7.1% 86
    ERA Transparency 83.1% 155 80.5% 135
    Eligibility Accuracy 97.7% 56 96.1% 70
    Benefit Reliability 0.3% 156 75.2% 116
    Enrollment Efficiency 83.0% 63 83.0% 54
    Enrollment Turn Around Time 63 days 161 55 days 126
  • #165 Superior Health Plan Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 46.4 days 152 39.1 days 124
    First Pass Resolve Rate 86.3% 154 85.4% 137
    Provider Collection Burden 2.4% 30 2.4% 23
    Denial Rate 16.1% 150 13.4% 131
    ERA Transparency 85.9% 148 69.2% 143
    Eligibility Accuracy 97.6% 60 98.0% 24
    Benefit Reliability 0.1% 157 0 140
    Enrollment Efficiency 92.0% 9 99.0% 2
    Enrollment Turn Around Time 28 days 65 51 days 125
  • #166 Medicaid-OK Medicaid

    Metric 2015
    Score
    2015
    Rank
    2014
    Score
    2014
    Rank
    Days in A/R 47.8 days 158 42.5 days 135
    First Pass Resolve Rate 84.6% 160 77.5% 145
    Provider Collection Burden 1.2% 6 1.9% 14
    Denial Rate 23.1% 160 35.2% 146
    ERA Transparency 90.5% 134 97.4% 63
    Eligibility Accuracy 95.8% 98 57.5% 148
    Benefit Reliability 0 158 0 140
    Enrollment Efficiency 73.0% 91 80.0% 58
    Enrollment Turn Around Time 21 days 38 10 days 18