AMA Ranks Payers' Claims Processes, Which are Often a 'Murky Mess'

For example, Cigna improved in this category from 66% to 83% while Humana improved from 84% to 93%. Coventry, however, went from 86.7% to 71.9% and HealthNet did not disclose the information. Medicare payments were the most closely aligned, with about 97.5% accuracy.

Another issue is the wide variation in how health payers deny claims.

"The inconsistency found among health insurers in 2008 continues to be demonstrated in 2009," the AMA said in a statement. "The wide variation in how often health insurers deny claims, and the reasons used to explain the denials, indicates a serious lack of standardization in the health insurance industry."

The survey was compiled through a sampling of the National Healthcare Exchange Services (NHES) database, which includes more than 2.5 million services billed within 1.6 million claims from physicians in 62 specialties and 200 practices in 29 states.

Compounding the problem with denials is that in many cases, the claims were correctly denied because the patient did not have coverage for a specific service in their plan. Eligibility continues to be the largest reason for denial, the survey results indicated.

"We need to improve the mechanics of answering the most basic of questions: Is the patient covered by a health insurance plan and (which) is it?" said Mark Rieger, NHES chief executive officer.

All of the records surveyed were taken from practices with electronic records systems. Rieger said the scores would probably be much lower if records from practices that had not yet adopted electronic databases had been reviewed.

Other process measures evaluated in the report card include whether physicians can accurately tell how long each plan will take to reimburse a claim or the amount of time before the physician receives the first check, and whether the plan clearly discloses pre-authorization policies and procedures online.

Another variable scored is how often health plans "claim edit," a process by which plans try to bundle separate billings under one category, which may reduce the amount the physician receives despite the number of times the patient was seen or the amount of care given.

At least four plans and Medicare were asked for comment on the report card.

"We value the AMA's report card on our performance as a way to help us improve how we work with the physician community…and have discussed the report card with the AMA throughout the year to identify improvements," Cigna spokeswoman Amy Turkington replied in an e-mail.

Such changes include revising its communication procedures, "so the information we already provide through our paper explanation of payment will be available on the electronic remittance as well," she wrote.

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