Critical Issues

Key Takeaways

• Commercial claims continue to outperform government and managed Medicaid plans.
• Traditional Medicare remains the most reliable payer.
• Medicaid continues to generate the lowest first-pass* payment rates.
• UnitedHealthcare consistently ranks among the lowest-performing payers across Commercial, Medicare Advantage, and Managed Medicaid, with particularly high denial rates.
• Significant slow-pay dollars remain tied up across all payer categories, indicating a substantial opportunity to improve hospital cash flow through payer accountability and payment timeliness.

*First-pass payment rates show how many claims were paid the first time they were sent to the payer versus sent back to the provider as a denial or for any other reason.