Anthem Blue Cross Claims Underpaid Due to System Error September 5, 2014 AMA, Payment Anthem Blue Cross, CalPERS , sequestration cut 0 The California Medical Association (CMA) has received physician complaints that Anthem Blue Cross is applying a sequestration cut to their payments, causing some claims to be underpaid. The issue affects claims in which Medicare is the patient’s primary plan and Anthem Blue Cross CalPERS is the supplemental plan. After Medicare processes the claim and forwards on, Anthem’s system appears to be applying a 2% sequestration cut to the amount they would normally pay as a supplemental plan in error. While the individual amounts are small, they can quickly add up for a practice. CMA escalated the issue to Anthem and has learned that a system issue is causing the underpayments. Anthem is reporting that it does not anticipate a fix until 2015, but will explore a work-around to prevent this error until the fix is implemented. CMA has asked Anthem to identify the claims that have been underpaid to date, automatically reprocess affected claims, and to continue reprocessing affected claims on a monthly basis until the fix is implemented. Comments are closed.
