Delayed claim detail (administrative and clinical) – Do you have claim scenarios that frequently involve delayed claim detail?.Review the following variables that may impact prompt claim filing internally: Does Anthem provide error reporting on claims which are not successfully filed with sufficient detail to allow you to correct any rejected claims.įurther, your internal process may need to be assessed to make sure that claims can be generated within the tighter filing deadline.Claim acknowledgment/error reporting process – do you get immediate acknowledgment that an Anthem claim was successfully filed with the insurer. ![]() Some of the variables that might impact your timely filing including the following: However, prior to initiating negotiation, it might be helpful to gather basic information regarding Anthem’s claim processing performance. Those practices who anticipate denials should initiate discussion with Anthem over the amendment. The amendment could increase lack of timely filing denials for many offices. If, after 30 days, we are unable to reach an agreement, your contract will terminate on or before October 1, 2019.” “If you object to the enclosed amendment, you must provide us with written notice of your appeal within 30 days of receipt of this letter. The notice also hints at the possibility of negotiating the time frame but makes it clear they are prepared to lose some contracted providers over the amendment. This means all claims submitted on or after Octowill be subject to a ninety (90) day timely filing requirement,” states the announcement. 1, 2019, your Anthem Blue Cross and Blue Shield (Anthem) Provider Agreement(s) will be amended to require the submission of all commercial and Medicare Advantage professional claims within ninety (90) days of the date of service. “Effective for all commercial and Medicare Advantage Professional Claims submitted to the plan on or after Oct. Each violation carries a maximum penalty of $10,000.Anthem has notified doctors and other providers that the timely filing window for professional claims is being shortened to 90 days. Poizner’s office filed the enforcement action against Anthem on Monday with the Office of Administrative Hearings.Īn administrative law judge will hear the matter. Nearly 40% of the violations in the Anthem case, 277, stem from allegations that the company failed to pay patient claims within 30 days as required by state law, officials said. ![]() That case is pending, Poizner said Monday. Officials said at the time that they had uncovered 133,000 violations of state laws and regulations over payments for medical care. Poizner’s office filed a similar complaint against Cypress-based PacifiCare in January 2008. The rate hikes would affect many of the 800,000 individual policyholders in California.Īnthem is not the only company facing scrutiny over the way it pays claims. Lawmakers in Sacramento and Washington are holding hearings this week on the increases, which have been postponed until May 1 amid the outcry. WellPoint and Anthem have faced intense criticism from consumers, regulators, members of Congress and the Obama administration over rate hike proposals of as much as 39% for customers with individual policies in California.
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