Anthem Agrees To Pay $1.62M to Hospitals for Owed Stop-Loss Claims
Anthem Blue Cross of California has reached an agreement with the Department of Managed Health Care to compensate hospitals after allegedly preventing them from receiving certain reimbursements for inpatient care, Payers & Providers reports.
Anthem typically reimburses hospitals with per diem payments for daily care. Once per diem payments reach a certain threshold, Anthem provides hospitals with a stop-loss payment.
In 2004, Anthem established a system requiring hospitals to submit claims for stop-loss payments to a different mailing address than claims for per diem payments, according to the agreement. The insurer also imposed strict claims submission deadlines, Payers & Providers reports.
DMHC took action against Anthem after multiple hospitals filed complaints about the insurer's claims submission policies.
In the agreement, DMHC alleged that Anthem's claims submission practices violated provisions of the California Health and Safety Code and resulted in the forfeiture of significant stop-loss payments.
The insurer consented to pay $1.62 million to an undisclosed number of hospitals by Nov. 25. The payment includes about $1.077 million in owed payments and more than $543,497 in penalties and interest.
Anthem admitted no wrongdoing in the agreement. The insurer also said it was pleased to settle the issue through a consent agreement rather than litigation (Payers & Providers, 11/11).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.