Oxendine Addresses Race and HMO Issues

The department is conducting a new round of examinations on all managed care plans and will impose additional fines if payments by managed care organizations are not made in a more timely manner, Oxendine says. Georgia law requires claims be paid within 15 working days or that a provider or policyholder be notified why a claim cannot be paid, the department says.

Since it started monitoring claims payments in fourth quarter 1999, the department says that no HMO reviewed has been 100 percent in compliance with the law.

Oxendine says that 10% of Humana's claims did not meet the requirements of Georgia's law and that the company's experience had actually gotten worse. Other companies being examined, he says, vary in performance, with some getting better, and others, worse.

"I told Humana and other HMOs that in the very near future we will look at them again," says Oxendine.

"I want the fine to get their attention. If $400,000 is not enough, I can make it more and I will," he continues.

Oxendine says he believes that companies can be at 100% compliance because of technology. Additionally, he says that if companies are late and pay 18% interest, they are considered to be in compliance.

Humana consented to the fine, he continues.

Humana issued a statement saying that "Humana is committed to timely payment of claims with its contracted providers, as well as its employer groups and members. The company has taken strong measures to resolve claims payment timeliness issues. In 2001, the company tracked a consistent upward trend in compliance with the 15-day payment regulation in Georgia."

Reproduced from National Underwriter Life & Health/Financial Services Edition, February 4, 2002. Copyright 2002 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.

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