Issues with Blue Cross Blue Shield of North Carolina's claims processing system led state officials to request new contract bids to manage its state health plan, the Charlotte Observer reported Jan. 19.
North Carolina state treasurer Dale Folwell said Jan. 4 the state plans to hand over management of its State Health Plan, which covers over 740,000 state employees, to Aetna in 2025. The state rejected challenges from BCBS North Carolina and UnitedHealthcare subsidiary UMR, the third bidder for the contract, on Jan. 20.
BCBS North Carolina has held the contract for over 40 years.
According to emails obtained by the Observer, State Health Plan officials expressed frustration with BCBS North Carolina's claims processing system. Emails also showed BCBS NC had dropped some providers from its network in error, or notified members their providers were dropped when they were not.
Eventually, State Health Plan Director Dee Jones told the company the state had "lost confidence" in BCBS and would issue a request for proposals for contracts, according to the emails.
A BCBS North Carolina spokesperson told the Observer it is not unusual to have issues "transitioning large data sets to new software."
"Blue Cross NC has worked closely and transparently with State Health Plan leadership to address these operational challenges, while providing the support that teachers, state employees and taxpayers expect and deserve," the spokesperson said.
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