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Wednesday, April 24, 2013

 

DMHC Secures Agreement with Anthem Blue Cross to Pay Health Care Providers

Total payment estimated at more than $3 million

(Sacramento) – The California Department of Managed Health Care (DMHC) announced today the settlement of an action taken by the DMHC against Anthem Blue Cross (Anthem) requiring it to pay health care providers money owed to them for the underpayment of interest on late paid claims with appropriate penalties for services dating back to 2007.

“The agreement ensures that health care providers will be paid fairly and accurately and underscores our commitment to providers,” said DMHC Director Brent A. Barnhart. “The proper payment of claims is crucial to the success of California's health care delivery system.”

The settlement agreement, which is effective today, requires Anthem to remediate provider claims submitted to Anthem for services provided between July 1, 2007, and April 30, 2011. Anthem must make these payments, with the appropriate penalties and interest, within 120 days. In addition to the remediation of claims owed to providers, within 90 days, Anthem must make changes in its claims payment and provider dispute processes, including improved training and auditing policies and procedures to ensure the appropriate payment of claims. Anthem must provide the DMHC with written confirmation that it has complied with the agreement.

The full settlement agreement can be found here

Providers with questions regarding remediation should contact Anthem’s provider relations department. 

About the DMHC

The DMHC regulates managed care health plans in California, protects the rights of approximately 20 million health plan enrollees, educates consumers on their health care rights and responsibilities, and preserves the financial stability of the managed health care system. Since 2000, the department has helped more than 1 million Californians resolve health plan problems through its Help Center. Information and assistance is available 24/7 at www.HealthHelp.ca.gov or by calling 1-888-466-2219.


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