Cigna's Phase I CORE certification leaves UnitedHealth the odd man out among top for-profit insurers

Cigna Corp., in Philadelphia has achieved Phase I CORE (Committee on Operating Rules for Information Exchange) certification as part of a multipronged effort to improve healthcare administration for providers. Cigna's accomplishment makes UnitedHealth Group Inc., the only one of the five largest for-profit health insurers that has not obtained at least Phase I CORE certification from the Council for Affordable Quality Healthcare (CAQH) in Washington, D.C. (Aetna Inc. and WellPoint Inc. have won both Phase I and Phase II certification, while Humana Inc. has completed Phase I and committed to doing Phase II. UnitedHealth is a CAQH member organization and has committed to both Phase I and Phase II certification, but the company hasn't completed either at press time.)

"CORE certification allows us to work with healthcare professionals to standardize many administrative functions to help make transactions more efficient and, therefore, less costly and time-consuming," Cigna spokeswoman Amy Turkington tells FierceHealthPayer.

In the 2010 PayerView Rankings of healthcare payers, Cigna came in first place for its denial rate, with only 4.2 percent of claims submitted by physicians requiring back-end work, as well as ranking second for claims resolved on initial submission, among eight major payers (the top five for-profits plus three other payers). However, Cigna didn't perform as well in other categories, ranking sixth in overall performance for major payers, eighth (last) in days in accounts receivable, sixth in provider collection burden, fifth in denial transparency, and last in eligibility accuracy.

Cigna expects to improve those rankings in the future thanks to the CORE certification and other initiatives, says Turkington. Additional steps taken by Cigna to enhance administrative functions include the following:

• E-visits: "CIGNA was the first national health plan to announce a countrywide agreement to offer reimbursable online physician consultations--aka 'virtual house calls,'" says Turkington. Online messaging for e-visits, scheduling in-office appointments and e-prescribing reduce the administrative workload of office staffs and lighten physicians' overbooked schedules, she points out.
• Streamlined billing: Cigna pays the insurance portion of a submitted claim plus the individual's portion (deductible or coinsurance) when funds are available in his or her consumer-driven health plan (CDHP) spending account or flexible spending account, she says. "In doing so, we reduce the physician's administrative costs for billing the patient separately, which can cost as much as $30 per bill."
• Online bill pay: Cigna offers plan members Intuit's Quicken Health Expense Tracker, "an online interactive way to guide individuals through their medical expenses and to pay their medical bills," says Turkington.
• Extended service hours: Cigna's call centers serve contracted providers and customers 24 hours a day, seven days a week, 365 days a year, she says. "Since introducing round-the-clock service on July 24, 2009, our call centers have received more than 1 million calls 'after hours.'"
• Reduced potential rebilling and refunding: Last year Cigna also launched a cost-of-care estimator tool "to assist healthcare professionals in reducing patient bad debt and improving their revenue cycle," says Turkington. The estimator "serves as the basis of pre-care financial discussions" by providing itemized cost estimates and explaining which costs are the plan member's responsibility. "To date, the estimator has provided financial responsibility information for more than 140,000 pre-care discussions regarding $22 million in patient liability between patients and their healthcare professionals," she notes.

Cigna hasn't set a timetable for Phase II certification. "We're evaluating what we can do in parallel with 5010 [the implementation of HIPAA 5010 electronic claims standards]," says Turkington.

To learn more:
- read the CAHQ press release about Cigna's certification
- review a 2009 CAHQ-commissioned study that explains the benefits of Phase I CORE certification

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