After a first notice in April, Greene County General Hospital in Linton, Ind., has issued a second breach notice to Anthem tied to ongoing claim payment disputes.
CEO Brenda Reetz said the estimated underpayment exposure exceeds $8.3 million.
Five things to know:
1. The hospital said Anthem has not cured a previous breach notice related to claim payment issues or fully resolved the financial impact to the hospital, according to a May 14 hospital news release shared with Becker’s.
2. The second notice alleges Anthem failed to apply the contract correctly and did not pay claims as required under the agreement.
3. After the first breach notice, an Anthem spokesperson said the hospital became aware of the problem only after Anthem identified it and notified the hospital in late February. The payer has been working directly with the hospital to resolve the claims both parties defended, an Anthem spokesperson said in a May 14 statement shared with Becker’s.
“Significant progress has been made in reviewing and reprocessing claims where appropriate, with only a small number remaining under review,” the spokesperson said. “We remain in frequent communication with GCGH to address our working relationship and help prevent similar issues going forward.”
4. Ms. Reetz told Becker’s that the active breach issue relates to an out-of-network adjudication error Anthem acknowledged. Based on current analysis, that issue alone accounts for approximately $1 million in underpaid claims tied to in-network claims processed under an out-of-network framework, Ms. Reetz said.
“The second, and much broader concern, is the overall pattern of underpayments identified across the Anthem relationship,” she said. “When looking beyond the breach population and evaluating total reimbursement performance, the estimated underpayment exposure exceeds $8.3 million.”
Ms. Reetz added that while the breach issue is important because it establishes a documented adjudication failure and contractual dispute process, the broader underpayment findings suggest the problem may be more systemic and operational in nature.
5. The hospital said Anthem identified one payment issue internally Jan. 8 but did not disclose it to Greene County General Hospital until March 15. During that time, the hospital continued seeking answers about unpaid or incorrectly paid claims, according to the release. The hospital said it has asked Anthem to review affected claims, correct improper payments and settle outstanding amounts.
Greene County General operates a 25-bed hospital, emergency room and four clinic locations.
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