The following are results from the National Health Insurer Report Card (NHIRC) years 2008-2013 that deal with payment timeliness.
Metric 1: Payer claim received date disclosed
Description: What percentage of time does the payer provide the date it received the claim (payer claim received date) in its electronic remittance advice (ERA) or explanation of benefits (EOB) response to the physician?
Metric 2: First remittance response time (median days)
Description: What is the median time period in days between the date the physician claim was received by the payer and the date the payer produced the first ERA? If a payer did not provide the Payer Claim Received Date, the most current date of service that was reported on the claim was used to perform the calculation.1
1If the payer did not report Payer Claim Recevied Date, DOS from the matching 837 was used instead.
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).