The California Department of Managed Health Care fined Centene’s Health Net plans $1.3 million over alleged “mishandling [of] provider payment disputes,” according to a Feb. 4 agency news release.
California levied an $850,000 fine on Health Net Community Solutions and a $450,000 fine on Health Net of California.
California requires insurers to acknowledge provider issues within two working days for electronic disputes and 15 working days for paper disputes. Resolutions must occur within 45 working days, and, if the issue is resolved in the provider’s favor, plans must relay due payments within five working days of a written decision.
Health Net Community Solutions did not acknowledge 6,587 nor rectify 36,848 provider disputes in a timely manner, the release said. Health Net of California did not acknowledge 19,048 nor rectify 15,368 provider disputes in that window, as well.
“Health plans must have an efficient process for managing provider payment disputes so unnecessary delays are avoided,” DMHC Director Mary Watanabe said. “Delayed payments strain the finances of doctors, hospitals and other providers, which can disrupt the healthcare delivery system and potentially impact patient care.”
The state also fined the plans, along with Magellan Health’s Human Affairs International of California, an additional $1.7 million in December due to timely access concerns.
“The provider dispute resolution letter process deficiencies date back to 2017-2023 and have since been resolved, as acknowledged by the Department of Managed Health Care in its press release. In addition to increased staffing, Health Net has established daily and monthly tracking mechanisms to improve workflow and oversight,” a Health Net spokesperson told Becker’s.
