Anthem pays hospitals $1.6M for stop-loss claims

Anthem Blue Cross of California has agreed to pay $1.62 million to settle charges that it had underpaid stop-loss claims to hospitals, according to Payers & Providers.

Anthem entered into the agreement with the California Department of Managed Health Care, a state agency that monitors many of the state's health plans.

As part of the settlement, Anthem will make $1.077 million in payments owed an unknown number of hospitals, with another $543,497 for interest and penalties. The payments must be made by Nov. 25.

According to the settlement statement, Anthem paid two types of hospital claims: per diem claims, and stop-loss claims once per diem claims reached a certain threshold. However, Anthem had set up a system where requests for stop-loss payments had to be directed to a different mailing address than claims for per diem payments, and had to be submitted under strict deadlines. The DMHC contended that this not only violated California's Health and Safety Code, but resulted in payment forfeitures. However, it did note that Anthem had made changes in its stop-loss claims submission policy after complaints from hospitals.

"We were pleased to resolve our disagreement ... through a consent agreement, rather than litigation," Anthem said in a statement, which also praised hospitals.

Anthem did not admit any wrongdoing as a result of agreement.

For more:
- read the Payers & Providers article
- read the settlement agreement agreement

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