Private Payers

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For related content, please also visit our webpages on Medicare Advantage, Administrative Simplification and Healthcare Reform
 

News and Resources

  • MGMA research: Strong correlation between overall satisfaction with payers and the accuracy and consistency of payers’ responses to questions 
  • Supreme Court upholds healthcare reform
  • Insurers to provide over $1 billion in rebates by August for not meeting medical loss ratio requirements, which stipulate that insurers in the large group market must spend at least 80 percent of premium dollars on medical care and quality improvement. HHS press release
  • See a breakdown of markets and states receiving rebate
  • MGMA Washington Counsel memo for Association members on the background of payer’s use of contract clauses preventing class action

MGMA Advocacy

  • MGMA comments on proposed Health Plan Identifier (HPID) rule. If implemented properly, the HPID has the potential to streamline the health plan identification process throughout the claims revenue cycle and increase administrative efficiency.
  • MGMA signs on in support of the AMA’s Physician Data Reporting Guidelines. These guidelines are aimed at getting physician data reporting entities to make their data reporting methodologies more cohesive and to use a standardized reporting structure that is easier to understand.
  • HHS releases final rule on healthcare Exchanges and a related fact sheet
  • MGMA comments on Electronic Funds Transfer rule
  • MGMA to HHS: include administrative costs incurred by providers as a component of insurers’ administrative costs in calculating medical loss ratios

Background

MGMA's Practice Perspectives on Payer Performance Study results

Each year MGMA focuses a study on seven large payers: Aetna, Anthem, CIGNA, Coventry, Humana, Medicare Part B and UnitedHealthcare. The results reflect members’ perceptions of the payer environment in areas of payer communications, provider credentialing, contracting, payment policies, system transparency and overall satisfaction. We use these results in our advocacy efforts and meetings with Medicare and private payers.

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