Anthem Likely To Defy Order To Pay Outstanding Claims

California state regulators ordered Anthem Blue Cross Blue Shield late last week to pay providers for outstanding claims owed during the last four years. However, Anthem is pushing back and might not comply with the order.


The California Department of Managed Healthcare (DMHC) identified errors in claims that Anthem processed since 2007, prompting it to demand the state's largest for-profit insurer pay the outstanding amounts it owes doctors and hospitals, reported the Sacramento Business Journal

Anthem, though, says it already settled the outstanding claims with DMHC when it paid a $500,000 administrative fine as part of a settlement agreement last year.

The settlement was a result of DMHC's claims audits in 2008 after providers complained of insurers' late and inaccurate payments and inappropriate claims denials. DMHC ordered several insurers, including Anthem, to pay providers, improve their claims processes, sign settlement agreements and pay administrative fines. All insurers involved have begun paying the outstanding claims except Anthem, noted the SBJ.

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Source: FierceHealthPayer