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.
Payer-Specific Claim Edits
Information is available through NaviNet®. Registration required.
Anthem Blue Cross of California (WellPoint, Inc. parent)
Contracted Fee Schedule
Registration required
Payment policies
Registration required. After registering, go to Provider manual
Payer-Specific Claim Edits
Registration required
CIGNA
Contracted Fee Schedule
Registration required
Prior Authorization
Registration required
Payer-Specific Claim Edits
Registration required
Coventry
Contracted Fee Schedule - Not available online
Payment policies - Not available online
Prior Authorization
Payer-Specific Claim Edits - Not available online
Medical policies - Not available online
Multiple Procedure Reduction Logic - Not available online
Transparency survey results - Not available
Health Net
Contracted Fee Schedule
Registration required. After registering, go to Policy and Procedures.
Payment rules
Registration required
Payer-Specific Claim Edits
Registration required. After registering, go to Policy and Procedures.
Humana
Contracted Fee Schedule
Registration required
UnitedHealthcare
Contracted Fee Schedule
Registration required
Payer-Specific Claim Edits
Registration required for Claim estimator
Medicare
Payment rules
Claims processing manual
Payer-Specific Claim Edits
National Correct Coding Initiative (NCCI edits)
Medical Unlikely Edits (MUEs)
