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Anthem Blue Cross agrees to pay $3.2 million owed to providers for improper claims payments

April 26, 2013


Anthem Blue Cross will pay more than $3.2 million owed to physicians and other health care providers on improperly paid claims dating back to 2007.


The agreement, announced this week by the California Department of Managed Health Care (DMHC), stems from claims audits launched by DMHC in 2008 of the seven largest health plans in California due to a growing pattern of complaints from providers regarding late and inaccurate payments and inappropriate claim denials. These audits, completed in 2010, found claims payment violations above the threshold allowed under California law at all seven health plans.


In response to the audits, DMHC required the plans to pay providers the money they were owed and to improve claims processes to prevent future errors. Plans were also ordered to pay administrative fines. Blue Cross is the last of the insurers to undertake provider remediation efforts.


Under the settlement, Anthem must make these payments, with the appropriate penalties and interest, within 120 days. The insurer has also agreed to make changes to its claims payment and provider dispute processes within 90 days, including improved training and auditing policies and procedures to ensure the appropriate payment of claims.


This settlement involves payouts to about 4,600 health care providers in the state.


Read the full settlement agreement.


Contact: CMA's reimbursement help line, (888) 501-4911 or economicservices@cmadocs.org.

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