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.
Access the newly released AMA Administrative Burden Index
As part of the 2013 NHIRC, the first-ever Administrative Burden Index (ABI) was created to encourage increased physician and payer engagement.
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
- 2013 NHIRC – full results
- Download a comparison of the results from 2008-2013
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.
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 2013 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.
Streamline your claims process. Access resources to help your practice become electronic or an ePractice, by using electronic eligibility verification, electronic claim submission, claim status, prior authorization/referrals, electronic remittance advice and electronic funds transfer.
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.