What’s happening: The California Department of Managed Health Care (DMHC) has taken enforcement actions, including a total of $8.5 million in fines, against Blue Cross of California Partnership Plan and Anthem Blue Cross for their failure to address payment disputes with health care providers in a timely manner.
What else to know: In addition to paying the fines, the plans must improve response times by removing barriers that create delays, monitoring provider disputes more regularly, and adding staff to handle provider disputes. Per two letters of agreement, Blue Cross is expected to complete the corrective actions before Dec. 31.
CHA has been in ongoing communication with DMHC about health care plan payment delays and denials, and the significant impact these shortfalls have on hospitals’ financial stability. CHA has made frequent requests for greater DMHC oversight on this important issue and is pleased that the department has responded with this action. CHA member hospitals that continue to encounter problems with health care plan response to payment disputes are encouraged to file a complaint on the DMHC’s provider complaint web page.
For more information, refer to the DMHC press release.
