Payer Web Sites: Contracted Fees And Payment Policies
Many health insurers allow contracted physicians to access a variety of information on their Web sites. This information includes, but is not limited to, contracted fee schedules and payment policies. The AMA's National Health Insurer Report Card looked at the Web sites of seven commercial payers and Medicare to determine which sites made their payment polices, contracted fee schedules and claim edits available to physicians. Please note that not all of the information is posted on the payers Web sites.
Aetna
Contracted Fee Schedule - Information is available through NaviNet®. Registration required.
Payment rules
Prior Authorization
Payer-Specific Claim Edits - Information is available through NaviNet®. Registration required.
Medical policies
Multiple Procedure Reduction Logic
See complete transparency survey results
Anthem Blue Cross of California (WellPoint, Inc. parent)
Contracted Fee Schedule Registration required
Payment rules Registration required.
Payer-Specific Claim Edits Registration required
Medical policies
Multiple Procedure Reduction Logic
See complete transparency survey results
CIGNA
Contracted Fee Schedule(Registration required)
Payment rules
Prior Authorization (Registration required)
Precertification List (Registration required)
Payer-Specific Claim Edits(Registration required)
Medical policies
Multiple Surgery Guidelines
Multiple Procedure Reduction Logic
See complete transparency survey results
Coventry
Contracted Fee Schedule - Not available online
Payment rules - Not available online
Prior Authorization
Payer-Specific Claim Edits - Not available online
Medical policies - Not available online
Multiple Procedure Reduction Logic - Not available online
Health Net
Contracted Fee Schedule Registration required. After registering, go to Policy and Procedures.
Payment rules Registration required
Prior Authorization
Payer-Specific Claim Edits Registration required. After registering, go to Policy and Procedures,
Medical policies
Multiple Procedure Reduction Logic
See complete transparency survey results
Humana
Contracted Fee Schedule Registration required
Payment rules
Prior Authorization
Payer-Specific Claim Edits
Medical policies
Multiple Procedure Reduction Logic
See complete transparency survey results
UnitedHealthcare
Contracted Fee Schedule Registration required
Payment rules
Prior Authorization
Payer-Specific Claim Edits Registration required for Claim estimator
Medical policies
Multiple Procedure Reduction Logic
See complete transparency survey results
Medicare
Contracted Fee Schedule
Payment rules Claims processing manual
Prior Authorization
Payer-Specific Claim Edits National Correct Coding Initiative (NCCI) edits
Medical Unlikely Edits (MUEs)
Medical policies
Multiple Procedure Reduction Logic
