Audit is the only language HMOs understand.
According to New Jersey Banking and Department of Insurance spokesperson Bill Heine, state insurance regulators are currently conducting a routine exam of one of six HMOs and plan on beginning another by the end of the year. By comparison, the best and worst performance mustered by an HMO in this study is Aetna. With 81 percent of its electronic claims for the study week paid in full within 30 days, Aetna topped the other five insurers in both categories. Thirty percent of paper claims submitted in the study received no response from the HMO within 40 days. However, only 38 percent of the claims submitted to Aetna were submitted electronically.