Anthem BCBS claims processing is still too slow, Maine providers say

Anthem Blue Cross and Blue Shield in Maine told providers in October 2021 that there would be delays in claims processing, but four months later, providers said little has changed, according to News Center Maine

The Oct. 13 memo blamed the delays on staffing shortages and a transition to a new provider data management system. 

"We sincerely apologize for these delays," the October memo stated. "We strive to process and pay claims as quickly and efficiently as possible and in accordance with the contractual agreements we have with our provider partners."

But two of the state's largest health systems — MaineHealth and Northern Light Health — said that while there has been some progress, there are still significant delays in processing claims. These delays represent millions of dollars that are in the air, the providers told News Center Maine

"There has been no improvement with out-of-state and Medicare Advantage claims," Suzanne Spruce, chief marketing and communications officer for Northern Light Health, told News Center Maine. "We meet monthly with Anthem to review outstanding issues."

Caroline Fontaine, executive director of the Maine Optometric Association, said one-third of claims are affected by delays, with many including coding errors. 

An Anthem spokesperson told News Center Maine that the payer has made significant progress since last fall.

"Anthem is processing claims in a timely manner," the spokesperson said. "In the last 12 months, 92 percent of claims within 14 days, and 98 percent within 30 days. We continue to work closely with the Maine Bureau of Insurance and have met, and will continue to meet with, provider associations across Maine, including the Maine Medical Association."

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