Payer Profiles

Payer profiles for 16 national and regional commercial health insurers, covering timely filing windows, prior authorization portal routing, appeal submission deadlines, and known denial patterns. Profiles include UnitedHealthcare, Aetna, Cigna/Evernorth, Anthem/Elevance Health, Humana, Blue Cross Blue Shield plans, Medicare Traditional, Medicare Advantage, Medicaid managed care, Centene, Molina Healthcare, and several regional carriers.

Each payer profile identifies the clean-claim timely filing window for original claims and for secondary billing, the prior authorization portal used for specialty services (Availity, Waystar, eviCore, AIM Specialty Health, or direct payer portal), the standard reconsideration and formal appeal turnaround times, and any known idiosyncrasies in claims processing that generate above-average denial rates for specific specialties or procedure categories.

Prior authorization portal routing varies significantly across payers: UnitedHealthcare routes most specialty PA through Optum PA (link from UHC Provider Portal), Aetna uses Availity with specialty carve-outs to AIM Specialty Health for imaging and radiation oncology, Cigna routes behavioral health and specialty drug PA through Cigna for Health Care Professionals (formerly Evicore for some specialties), and most BCBS plans use Availity with regional variation for specialty carve-outs.

• Prompt pay statutes — enforce payment timelines by state
• Timely filing calculator — deadlines by payer and date of service
• Specialty guides — denial pathways and prior auth by specialty and payer
• Community payer alerts — reported denial pattern changes