Changes to Anthem insurance software delay payments to therapists



Anthem Blue Cross Blue Shield said a change to its vendor data management system and hiring issues were causing delays in processing claims in Maine.

BIDDEFORD, Maine – Some therapists and health care workers in Maine are not receiving payments from Blue Cross Blue Shield Anthem insurance due to a software change in the company.

Anthem said in a statement on October 13,

Anthem Blue Cross and Blue Shield in Maine experience delays in processing supplier requests and supplier maintenance forms, which creates delays in our ability to process supplier complaints. These delays are due to several factors, including hiring issues related to the pandemic and a new supplier data management system. We sincerely apologize for these delays.

The company said it is prioritizing the processing of Maine supplier maintenance forms, accreditation requests and associated complaints.

“We have deployed additional resources to assist the Maine Provider Solutions team and hired new staff to focus on processing maintenance requests and forms, which in turn will allow supplier complaints to be dealt with in a timely and efficient manner. precise, “the company said in a statement. . “We apologize for any delays this may have caused, and we ask any Partner Provider facing such challenges to contact their Anthem Care Provider Experience Representatives.”

Therapists like Rudy Skowronski hope this problem will be resolved soon. He said the software change meant his NPI (National Supplier Identifier), which is essentially an identification number, had not migrated properly to the new system. He said he noticed the issue about four months ago and has been communicating with Anthem ever since, with no resolution.

“It’s just the glitches that happen when things change,” Skowronksi said. “So they can’t pay me because I could fraudulently bill them. Things don’t match in their system. The problem is, we’re about 4 months away and they haven’t been able to fix it yet. the problem.”

The Maine Insurance Bureau told him in an email that “many suppliers” in the state are facing the same problem. The Bureau did not have a precise figure on the number of suppliers facing similar non-payment issues.

“We are aware of the issues and have been in regular contact with Anthem regarding their efforts to resolve them. We are also beginning a review of Anthem which will include a review of vendor issues, ”Superintendent Eric Cioppa wrote in a statement.

“It’s not that it’s a huge chunk of my income. It’s about 20 percent of my income, but it takes a toll on you financially,” Skowronski said. “I’ll probably get paid, but I don’t know if it’s a month, a week, a year, every time Anthem fixes his computer.”

Skowronski, who specializes in PTSD and trauma patients, said he would continue to see his patients who have Anthem pro bono insurance, for now. He also warned his patients that by the end of the month, he may have to ask them to pay in cash: $ 75 an hour.

He said the reason for his benevolence was the lack of therapists available in the state at this time.

“In good conscience, I just can’t throw the people I deal with in this market,” Skowronski said. “There is an interaction here that goes beyond money. You are doing the right thing. Whether or not it costs you as a person, you are doing the right thing.”

NEWS CENTER Maine will update this story when more information becomes available.


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