The following are results from the National Health Insurer Report Card (NHIRC) years 2008-2013 that deal with cash flow.Metric 2A: Cash flow analysis
Description: On what percentage of claims was the first payment on the claim received within the following time ranges: 0-15 days, 16-30 days, 31-45 days, 46-60 days and greater than 60 days? This metric does not attempt to quantify the electronic funds transfer (EFT) payment lag time where the EFT payment does not accompany the ERA.1
|Greater than 60 days||0.14%||0.13%||0.13%||0.21%||0.31%||0.25%||0.15%||0.26%|
Metric 2B: Percentage of claim lines paid $0
Description: What percentage of claim lines are paid $0 for any reason (e.g. claim edits, denials and patient responsibility)?
*Metric 2C: Patient responsibility as a percentage of payer allowed amount
Description: What percent of the payer's allowed amount for a service is the patient financially responsible for?
Metric 3: Electronic funds transfer (EFT) adoption rate
Description: What percentage of physician practices have received EFT payments by the payer?
Metric 3A: EFT adopters still receiving checks
Description: What percentage of physician practices that have received EFT payments from a payer have also received payments by check from the payer during the same period?
1Differences between payers in the reported timeliness metrics may not represent actual differences in the time taken by physicians to receive payment. More detailed information on this can be found in the "2013 National Health Insurer Report Card: Statement of methodology, including the step by step guidance".
HCSC = Health Care Services Corporation
UHC = UnitedHealthcare
The AMA NHIRC results are based on data pulled from the nationally mandated Health Insurance Portability and Accountability Act of 1996 (HIPAA) electronic standard transactions. The technical references for these transactions are the electronic remittance advice (ERA) (HIPAA ASC X12 835 Health Care Claim Payment/Advice Transaction) submitted to a physician in response to the receipt of an electronic claim submission (HIPAA ASC X12 837 Health Care Claim--professional transactions).