Blue Cross Blue Shield of Minnesota entered a consent order with the state Department of Commerce after it wrongly denied more than 8,000 claims for medical devices and supplies used to treat sleep disorders.
The equipment and supplies in question were for a common sleep treatment called continuous positive airway pressure (CPAP).
The Eagan-based health insurer will pay a penalty of $83,890, according to a settlement agreement released this month by Commerce Department officials.
Blue Cross said it began working with its vendors on the issue, which involved a total of 8,389 claim denials, before it was notified by state insurance regulators.
“The issue stemmed from a code group combination that did not align with vendor guidelines and a provider billing Blue Cross for more than one month's worth of refills on a single claim,” the health insurer said in a statement. “The vendor has subsequently made appropriate system adjustments to ensure these claims are processed as approved expenses.”
A Blue Cross spokesman said the contractor, Evicor, a unit of Connecticut-based Cigna, was contracted by Blue Cross to process medical necessity reviews and prior authorizations around 2019. At the time, the Minnesota Hospital Association filed complaints with state regulators about Blue Cross's payment delays and denials related to the contractor's work.
Blue Cross said in a statement this week that issues with paying claims related to sleep therapy have not caused delays for patients receiving CPAP supplies. The insurer added that the issues were limited to payments to medical providers and that all claims have since been paid with interest.
According to the consent order, Blue Cross agreed to dispose of the matter informally, without a hearing.
