As recently reported, the California Medical Association (CMA) began receiving complaints earlier this year that Operating Engineers Health & Welfare Fund, a Southern California self-funded benefit plan leasing the Anthem Blue Cross Prudent Buyer network, was not paying claims in a timely manner. Some physicians reported that the fund was seven months behind in paying claims.
As a self-funded plan, Operating Engineers is mandated by the Employee Retirement Income Security Act of 1974 (ERISA) to pay claims within 30 calendar days of receipt. CMA and Blue Cross have been engaged in discussions with Operating Engineers to address the backlog of claims over the past several months.
CMA has learned that Operating Engineers intends to process the backlog of claims by the end of August. In a notice to physicians, Blue Cross reports that Operating Engineers has also committed to remain compliant with the ERISA standards once the backlog of claims has been addressed. CMA will work closely with Blue Cross to monitor Operating Engineers’ progress.
Are your payors solvent?
Physicians are reminded that one of the symptoms of an insolvent payor is the failure to pay claims in a timely manner. To help physicians monitor the financial health of their contracted payors, CMA has put together a "Payor Solvency Checklist," available free to members in CMA's online resource library. This checklist includes instructions on how to research and monitor the financial solvency of your contracted medical groups/IPAs and discusses the options available to physicians in the event that a payor stops paying claims.
Contact: CMA’s reimbursement help line, (888) 401-5911 or firstname.lastname@example.org.