CA Slaps Health Plans for Delaying Payments
"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.
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
- CMS Sets 2014 Pay Rates for Hospital Outpatient and Physician Services
- FDA hopes hospitals will switch to newly regulated pharmacies
- New G-Codes to Pay Doctors for Broad Array of Non-Face-to-Face Care
- Not-for-Profit Hospitals Find Opportunity Amid Uncertainty
- The Most Polarizing Topics in Healthcare IT
- Why You Should Involve Patients in Nursing Handoffs
- The 5 Biggest Healthcare Finance Trouble Spots
- States Rejecting Medicaid Expansion Forgo Billions in Federal Funds
- How CPOE Will Make Healthcare Smarter
- Substance Abuse Resurfaces Among Anesthesiologists in Training