"Claims pending" letters cause a stir

New Hampshire doctors say Anthem is stalling on paying claims, but the insurer says it is just complying with a new prompt-pay law.

By Julie A. Jacob, AMNews staff. Sept. 10, 2001.

Medical groups in New Hampshire are reporting that since a prompt-pay law went into effect early this year, Anthem Blue Cross Blue Shield of New Hampshire has been sending out "claims pending" letters that physicians fear are allowing the insurer to delay payment on claims.

Physicians say they are concerned that Anthem is using the claims pending letters as a way to delay payment on claims beyond the 15-day payment limit for electronic claims and 45-day limit for paper claims that the law requires.

New Hampshire's prompt-pay law, which went into effect in January, allows insurers to extend payment beyond those dates if it sends out a letter notifying physicians that claims are pending while the insurer gathers additional information.

The New Hampshire Medical Society surveyed medical groups in April to see how insurers were complying with it, said Janet Monahan, the medical society's spokeswoman.

While the medical society did not receive enough responses to make the survey statistically significant, "the survey results we got back didn't paint a good picture," Monahan said.

Medical groups who have contacted the state medical society report that Anthem is sending them letters stating that some claims are under review for things such as "verifying claims pricing for payment," "reviewing member eligibility record" and "reviewing for payor technical edits."

"It is our impression that they are sending out these letters as a stall tactic," Monahan said.

The Pittsfield Medical Center in Pittsfield, N.H., has been receiving claims pending letters for things such as reviewing member eligibility, said practice administrator Marcia Stockman. [...]