CA Slaps Health Plans for Delaying Payments

Cheryl Clark, for HealthLeaders Media , November 30, 2010

"The DMHC found that plans are generally meeting state requirements for timely payment and they will work collaboratively with the state and providers to meet the full extent of regulatory requirements and improve performance," said CAHP President & CEO Patrick Johnston.

"Plans are committed to ensuring our members have access to the health care they need every day.  We have long recognized that the administrative side of health care coverage can take valuable time away from patient care, which is why plans have been working to streamline processes both at the health plan level and in doctors? offices," Johnston said.

The DMHC is the only stand-alone state HMO watchdog agency in the nation, and covers plans that enroll more than 21 million Californians. Since 2004, the department's provider complaint unit's investigations have resulted in $22 million in additional payments to providers.

Some of those were because of systemic claims practices that violate state law, and a $1.6 million fine against Anthem Blue Cross, paid to seven Southern California hospitals that complained to DHC about claims they felt were wrongly denied.

DMHC staff said that they are working with health plans to make sure improperly delayed or denied claims are paid back to the providers, and urges California hospitals and doctors to visit the agency's web site for information about fighting wrongly denied claims.

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