Insurance Commissioner: Anthem To Readjust Claims For Behavioral Health Providers
Approximately $400,000 In Reimbursements Will Be Retroactive to January 1, 2013
Insurance Commissioner Thomas B. Leonardi today announced that Anthem Health Plans, Inc. has agreed to adjust its medical billing code reimbursement procedure for payments to behavioral health providers and will begin reprocessing approximately 28,000 claims retroactively to January 1, 2013.
“Through the Department’s regulatory oversight of Anthem claims payment practices it was determined that Anthem had to revisit the way it was applying a new set of medical billing codes for reimbursement of claims and make the proper adjustments,” Commissioner Leonardi said. “As a result, the carrier has now provided the Department with a remediation plan that will make the fair and correct adjustment for providers for all affected services on or after January 1.”
The Commissioner said preliminary estimates indicate Anthem will retroactively reprocess thousands of claims amounting to about $400,000 in additional payments. The carrier will begin notifying affected providers on May 1 and will also explain the change in the billing code reimbursement procedure to its members. The Commissioner said that Anthem has cooperated fully with the Department throughout the oversight process, which began in early March after the Department received a formal complaint from providers.
Medical billing codes, which are issued by the American Medical Association, are what carriers use to identify the services they pay for and what providers use to bill for reimbursement. A new set of billing codes was issued by the AMA for 2013.
The Department will continue to monitor this action plan going forward. Anthem will provide the Department with monthly reports showing the total number of claims reprocessed, the total amount paid as a result of the reprocessing and the number of providers affected. The Commissioner said the Department expects a final summary report from Anthem approximately 60 days from the time the readjustments begin.