Highmark fined $205K for wrongly denied claims, untimely payments

The Pennsylvania Insurance Department fined Highmark Inc. $205,000 for violations including incorrectly denied claims, untimely payments and violations of mental health parity requirements. 

The insurance department found the issues during an audit of the state's largest health insurers. The time period audited was from January 2017 to March 2018, according to a Feb. 9 news release from the department. 

The insurance department ordered Highmark to reprocess incorrectly processed claims and ensure members receive timely services for enrollment and billing issues. 

In a statement to the Pittsburgh Post-Gazette, Highmark said it cooperated with the insurance department during the review processes. 

"The [department], however, had concerns with certain operational areas, such as timeliness of claims payment and resolving billing and enrollment issues," a spokesperson said. "As a result, Highmark has paid $205,000 to the Commonwealth in settlement of the review." 

In January, the Pennsylvania Insurance Department ordered Geisinger Health Plan to pay $125,000 in fines for incorrectly denied claims and Capital Blue Cross to pay $85,000 in fines.

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