Based on these measures, Aetna was the best payer for providers to work with in 2007, jumping up from second place last year among national payers.

Aetna reduced its denial rate 10 percent since last year’s report, giving it the best denial rate among the national payers. It also has, by far, the fewest days in A/R at 26.86, beating its nearest competitor, Cigna, by nearly six days.

Paul Marchetti, head of Aetna’s national networks and contracting services, credits transparency for the company’s low denial rates.

“We were one of the first ones to put claims rules on the Web site,” Marchetti says. Those public rules “explained our bundling and unbundling logic, how we processed claims, what we would deny for. …Transparency is really the bottom line. Our rules are transparent and you can go out and see the rules prior to submitting a claim.”

The goal is to “eliminate unnecessary costs on both sides. I think the goals are pretty much aligned here.” Physicians understandably complain about the payers’ inscrutable bureaucracies, but theories about payer conspiracies aimed at getting physicians to simply give up chasing payments have always seemed unlikely to us. Remember, it costs payers a lot of money to process denials, too, so they have an interest in streamlining processes.

Aetna works regularly with athenahealth to improve its PayerView metrics, which has positively impacted its approach.

Cigna and Humana ranked second and third, respectively.

Humana improved its first pass resolve rate more so than its competitors. In fact, Humana improved in every measure except patient liability. “It’s the way the industry is going,” comments Mark Smithson, vice president of provider process and network operations for Humana. “We are going to have more patient responsibility and that is just the way it is.” Humana is adding tools to make patient liability easier for physicians to manage, he adds. It’s not so much expecting patients to pay that is the problem, Smithson argues, it’s equipping physicians to deal with it.

“We’re seeing some of the fruits of our efforts coming into play in the latter part of the year. I think we have some real opportunity next year,” he concludes.

Medicare was in the middle of the pack. Its fourth-place showing was respectable largely because its billing rules are public and mostly comply with CCI edits — and because Medicare, being a government payer, has little involvement in the consumer-directed movement. You may have noticed regional differences in Medicare’s performance. These are mainly driven by variations in athenahealth’s specialty mix.

UnitedHealth Group was hurt in our rankings by its more-frequent practice of passing charges onto patients. It has more than 2.3 million individuals enrolled in a consumer-driven health plan, more than double its closest competitor, according to Daryl Richard, vice president of communications for the company.

Richard doesn’t think this should count against United: “This is not a measurement of how accurate or timely we process claims, and because UnitedHealth Group is the market leader in consumer-driven health plans, this measure unfairly impacts our ranking and skews the perception of our claim performance. …We have a number of programs and tools, such as a claim estimator tool, real-time adjudication, and debit card technology for consumers linked directly to their health accounts, which ensure higher deductibles common with consumer-driven plans do not put additional liability on the physicians.”

Richard further notes that some of United’s tools, including real-time adjudication and electronic payment and statements, which speed up payment, weren’t being used by athenahealth clients until late in 2007. Therefore, its performance may look better next year.

Also, PayerView next year will likely reward payers for helping physicians with patient liability.

And the worst performing plans? Well, TRICARE, last on our list this year, disagrees with our data. For example, we assess days in A/R from date of service. TRICARE, using a different standard, reports that it takes care of all the claims it gets in 7.6 days, on average. Any additional processing time is caused by providers’ and clearinghouses’ delays in getting claims to it in the first place.