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.
