National Health Insurer Report Card
The AMA publishes an annual report card of the claims revenue cycle activities of the major commercial health insurers and Medicare. The NHIRC provides metrics on the timeliness, transparency and accuracy of claims processing of these payers in an effort to educate physicians and the public, and to reveal opportunities for improvement.
These results may not be typical across all practices. The practices profiled in the NHIRC have adopted best practices for electronic data interchange and contract compliance. Also, the company that compiles the results uses information from the standard transactions in ways that are not described in the implementation guide in order to help improve match rate. To enable all physician practices to achieve results similar to those reported here, all health insurers must be fully transparent and compliant with the electronic data interchange standards.2012 NHIRC
Review the report results by section or as a whole.
- Payment timeliness
- Cash flow
- Administrative requirements – prior authorization
- Claims edit sources & frequency
- Improvement of claims cycle workflow
- 2012 NHIRC – full results
- Download a comparison of the results from 2008-2012
See how insurers and payers performed in areas that will have a positive impact on improving the claims process. This webinar provides an overview of the past year’s performance—insurer improvements and continued challenges—and explains what the results mean to physician practices now and in the future.
Understand the method by which the National Health Insurer Report Card is developed. This document is an informative brief on the AMA’s process for developing a report that is comprehensive, accurate and defensible.
This press release provides a high-level summary of 2012 NHIRC findings, and provides an explanation of how those numbers translate to spending across the health care industry.
The National Health Insurer Report Card is the cornerstone of the AMA’s “Heal the Claims Process”™ campaign, which aims to streamline claims processing through the use of electronic health care transactions and reduce the administrative cost of claims processing from 14 percent of gross revenue to just 1 percent.
- “Go electronic” with help from the AMA’s toolkits and webinars about each of the electronic health care transactions.
- Join the growing network of campaign supporters. Sign the campaign pledge to demonstrate your commitment to claims processing efficiencies.
Join your peers in the AMA’s Paperless Practice Group online community to ask questions, offer tips and access resources about automating the practice and using electronic health care transactions. Designed to encourage dialogue between physician practices, health insurers and intermediaries, this online community lets you be part of an informative conversation covering a range of topics on practice efficiency.
The AMA keeps an archive of past National Health Insurer Report Cards. These past reports may be a useful resource for understanding health insurer performance over time.
Sign up for the AMA's free Practice Management Alerts to receive timely updates on new practice management resources and tools to help you implement claims processing efficiencies and automate your practice. You'll also receive alerts about unfair payer practices and ways to address them.