I am writing to see if anyone has had success with the formal relief available under state statutory requirements for payments of clean claims and, if so, how you demonstrated failure to comply.
In Maryland, payer penalties escalate if the state determines that a payer's failure to pay claims timely rises to the level of a "business practice." This threshold is undefined.
We are specifically concerned with a payer practice where the payer's claims processing technology overwrites the date that a claim was received, replacing the received date with the date that the payer processed the claim. While our members can demonstrate the time period between when they submitted claims and when they received payment, the payer's system cannot accurately report those timeframes. It is thus unable to accurately report its compliance with the statutory prompt pay requirements.
I am trying to evaluate how we can best collect data from our members to demonstrate that claims are paid outside the statutory requirements and that the payer's inability to accurately track the data rises to the level of a business practice that violates the statute.
Curious to hear examples of successful data collection and advocacy strategies, or just take advice from the peanut gallery.
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Shannon Hall
Executive Director
Community Behavioral Health Association of Maryland
Catonsville MD
410-788-1865 ext 2
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