Health Care Service Corp.’s Blue Cross and Blue Shield of Texas filed a lawsuit against medical billing company Zotec Partners Dec. 18, alleging “abuse” of the No Surprises Act’s independent dispute resolution process, according to filings from the Eastern District of Texas’ federal court.
The No Surprises Act aims to limit surprise billing, forming the resolution process to address payment disputes between insurance companies and out-of-network providers.
BCBS of Texas accused Zotec of knowingly instigating “thousands” of disputes that were not eligible for arbitration, such as by submitting false information. The insurer said Zotec sometimes ignored state law, timelines for the IDR process and eligibility parameters for claims. “Batching” — or bundling multiple claims into one IDR process — has been another concern, with BCBS of Texas saying Zotec “overwhelms” the insurer by including 66 unique items or services on average.
The complaint requested compensation and a court order that would block Zotec from launching ineligible cases going forward.
“The claims mischaracterize both our services and our compliant practices and are without merit. This matter stems from a disagreement regarding the interpretation and application of eligibility requirements for the independent dispute resolution process, and we believe that this lawsuit, and others similarly alleged against other industry participants, may be intended to create a chilling effect on provider rights to seek fair reimbursement,” a Zotec statement shared with Becker’s said. “Zotec has consistently operated in good faith and in accordance with applicable laws and regulations.”
