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System error causing some Anthem Blue Cross claims to be underpaid



September 04, 2014
Area(s) of Interest: Commercial Payors Payor Issues and Reimbursement 

The California Medical Association (CMA) has received physician complaints that Anthem Blue Cross is applying a sequestration cut to their payments, causing some claims to be underpaid. The issue appears to affect claims in which Medicare is the patient’s primary plan and Anthem Blue Cross CalPERS is the supplemental plan. After Medicare processes the claim and forwards on, Anthem’s system appears to be applying a 2 percent sequestration cut to the amount they would normally pay as a supplemental plan in error.


While the individual amounts are small, they can quickly add up for a practice.


CMA escalated the issue to Anthem and has learned that a system issue is causing the underpayments. Anthem is reporting that it does not anticipate a fix until 2015. Until the fix is implemented, Anthem is exploring a work-around to prevent this error.


Again, this issue only affects the supplemental payment amount on claims in which Medicare is the primary payor and Anthem Blue Cross CalPERS is the supplemental carrier.


CMA has asked Anthem to identify the claims that have been underpaid to date, automatically reprocess affected claims, and to continue reprocessing affected claims on a monthly basis until the fix is implemented. CMA will report any further details as we hear back from Anthem.

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