The California Department of Managed Health Care has fined Anthem Blue Cross and its Medicaid plan a total of $8.5 million for failing to address claims payment disputes in a timely manner with physicians, hospitals and providers.
The plans failed to acknowledge a total of 98,955 provider disputes within required timeframes, and a total of 32,635 provider disputes were not resolved in a timely manner, according to a Sept. 27 news release from the state.
Anthem is taking corrective actions, which includes monitoring provider disputes more regularly, removing barriers that delay resolutions, and adding staff to dispute teams. The company has also agreed to pay the penalties, which include a $5 million fine for Blue Cross of California Partnership Plan (Medicaid) and a $3.5 million fine for Anthem Blue Cross.
"Anthem Blue Cross values the relationship with its care providers and is committed to ensuring the timely resolution of all provider disputes," a spokesperson for parent company Elevance Health told Becker's. "We have worked with the Department of Managed Health Care on a resolution to these matters, and made internal policy changes, oversight structural changes, as well as targeted investments in staff levels, systems, and reporting to ensure provider disputes are acknowledged and resolved in a timely manner."