IN, OH state medical groups demanding claims payment from Anthem

A pair of state medical associations are asking state regulators to determine why WellPoint subsidiary Anthem has been substantially delayed in paying claims and struggling to handle other basic administrative functions. The Indiana State Medical Association has just made its request, and the Ohio State Medical Association filed in October 2008. Both have seen problems with Anthem since late 2007, the groups said.

Doctors with both trade groups have said that they've seen delays of as much as several months in claims payments; payment errors, such as paying patients directly for in-network care; payments to wrong physicians; and denying unpaid claims as duplicates. Meanwhile, the doctors say that they're unable to reach customer service and resolve these issues due to excessive wait times for customer service staff.

This is happening despite the fact that Ohio has a prompt-pay law in place that requires health plans to pay clean claims within 30 days unless more documentation is needed, and Indiana requires paper claims to be paid within 45 days. Not only that, under a class-action suit settled in 2005, WellPoint is required to pay clean electronic claims within 15 days, and paper claims within 30 days.

An Anthem spokeswoman has said that the problems have been caused by its adoption of a new system to process claims under its BlueCard network, which lets members of Blues plans in one state use networks created by Blues plans in other states.

To learn more about this payment issue:
- read this American Medical News piece

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