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Anthem Health to reprocess claims after underpayment

By Lee Howard

Publication: The Day

Published April 25. 2013 4:00AM

Anthem Health Plans Inc. has agreed to reprocess thousands of claims and reimburse health care providers in Connecticut about $400,000 for underpayments, state Insurance Commissioner Thomas B. Leonardi announced Wednesday.

Leonardi said Anthem, based in Wallingford, has been using an incorrect medical billing procedure since the first of the year. It will immediately begin reprocessing about 28,000 claims for behavioral health reimbursements dating to Jan. 1, he said.

"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," Leonardi said in a statement. "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."

Anthem is expected to begin notifying health care providers about the underpayments starting May 1. Providers had alerted the insurance department to the situation.

The American Medical Association changed its billing code system this year. The code helps insurance providers identify which services they are paying for and what the proper compensation should be.

Donna Tommelleo, an insurance department spokeswoman, said Anthem's way of interpreting the coding of behavioral-health services was inconsistent with the way other carriers were applying the same codes.

"It was a routine oversight matter," Tommelleo said.

Tommelleo added that it is possible individual policyholders could be due compensation from their health care providers related to behavioral health underpayments. Anthem will reach out to policyholders to let them know of the situation, she said, and anyone who believes Anthem did not properly compensate a service provider is also invited to contact the insurance commission at (860) 297-3800.

The insurance department said an investigation of the underpayments began in early March, and that Anthem had cooperated in the process. Now that an agreement has been reached, the department said it plans to monitor the situation and issue a final report within about two months.


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