Rankings

HOW WE GRADE

Our analysis is based upon Payer’s policy changes. Every month hundreds of policies are changed to meet Payers internal objectives, keep up with medical technology, control utilization and manage payment to providers.

Our rankings examine four major categories, under which each insurance company is given a score. The more points accumulated, the worse companies fare. Points are designated based on multiple criteria, with each metric carrying a different weight.

Payers are ranked under:

1. Cost to Provider (CP)

2. Volume of Change (VC)

3. Clarity of Communication (CC)

4. Notification Period (NP)

ABOUT THE MEASURES

1. Cost to Provider (CP) takes into account policy changes or initiatives affecting revenues for physicians and other providers, and those that add more or less administrative time or complexity to a process in order to adhere to changes. Examples include implementation or withdrawal of pre-authorization, pre-certification, notification, and referral processes; timelines or modified processes that require more or less resources in order to comply with changes; and claims, coding or data errors or improvements resulting in more or less efficiency.

These points account for 50% of the aggregate score.

2. Volume of Change (VC) takes into account the total number of policy and procedure changes experienced by physicians in a given network. Points are determined by measuring the volume of change by each insurance company compared to percentage of overall volume change.

These points account for 18% of the aggregate score.

3. Clarity of Communication (CC) indicates how well or how poorly insurers make policy information available on their web sites and how clearly those changes are communicated in updated policies. Of the insurers ranked, their web sites are utilized as the primary communication tool for notifying network participants of changes to policies and procedures.

This measurement captures whether insurers’ clearly identify a new or modified policy, its effective date, and what changes actually occurred. The easier it is to find medical policies and updates on the site, the fewer points allocated to the insurer.

Additional points are given to insurers that keep their policies and network news behind a log-in barrier.

These points account for 25% of the aggregate score.

4. Notification Period (NP) measures the time elapsed between when an insurer posts notification of a policy or procedure change and the date upon which the change becomes effective.

We grade insurers on how much notice they give providers of their intent to change a policy or procedure – the less time between the posting and effective dates, the more points accumulated. We believe that at least thirty days of notification is necessary for providers to respond and adapt to changes. Payers that post 30 days or more ahead of effective date accumulate no points.

These points account for 7% of the aggregate score.

The data we use to rank insurers comes from

MPV’s Payer Policy Alert subscription service.

A system created and developed by the Verden Group, MPV tracks policy changes by insurer and specialty. You can obtain further information and sign up for the subscription service at mpv.com/sol_payer_alert.php

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Verden Team

We rank insurance companies from a physician’s perspective. See how payers stack up based on cost of participation, communication and policy change volume.