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Some Maine therapists, health care workers not getting payments from Anthem insurance due to software change

Anthem Blue Cross Blue Shield said a change of its provider data management system and hiring challenges is causing delays in processing claims in Maine.

BIDDEFORD, Maine — Some therapists and health care workers in Maine are not receiving payments from Anthem Blue Cross Blue Shield insurance due to a change in software at the company.

Anthem said in a statement on October 13,

Anthem Blue Cross and Blue Shield in Maine is experiencing delays in the processing of provider applications and provider maintenance forms, creating delays in our ability to process provider claims. These delays are due to several factors, including hiring challenges related to the pandemic and a new provider data management system. We sincerely apologize for these delays.

The company said it prioritized the processing of Maine provider maintenance forms, credentialing applications and associated claims. 

"We have deployed additional resources to assist  Maine Provider Solutions team and hired new staff to focus on applications and maintenance form processing which in turn will allow the providers’ claims to be processed in a timely and accurate manner," the company said in a statement. "We apologize for any delays this may have caused, and we ask any provider partner experiencing such challenges to contact their Anthem care provider experience representatives."

Therapists like Rudy Skowronski are hoping this problem gets fixed soon. He said the change in software meant his NPI (national provider identifier), which is essentially an ID number, did not migrate properly to the new system. He said he noticed the problem about four months ago, and has been communicating back and forth with Anthem since, with no resolution.

"It's just the glitches that happen when things change," said Skowronksi. "So they can't pay me because I might be charging them fraudulently. Things don't match in their system. The difficulty is we're about 4 months in and they haven't been able to fix it yet."

He's not alone.

The Maine Bureau of Insurance told him in an e-mail that "many providers" in the state are facing this same problem. The Bureau did not have a specific number of how many providers are facing similar issues of lack of payment. 

“We are aware of the issues and have been in regular contact with Anthem regarding their efforts to resolve them. We are also in the process of beginning an examination of Anthem which will include an examination of provider-related issues," Superintendent Eric Cioppa wrote in a statement.

"It's not that it's a huge part of my income. It's about 20 percent of my income, but it wears on you financially," said Skowronski. "I probably will get paid, but I don't lknow if it's a month, a week, a year, whenever Anthem fixes their computer."

Skowronski, who specializes in patients with PTSD and trauma, said he will keep seeing his patients who have Anthem insurance pro bono, for now. He also warned his patients that by the end of the month, he may need to ask them to pay cash: $75 per hour.

He said the reason for his benevolence is the lack of available therapists in the state right now.

"In good conscience, I just can't dump the people I am providing care for into that market," said Skowronski. "There's an interaction here that goes beyond the cash. You do the right thing. Whether or not it costs you as a person, you do the right thing."

NEWS CENTER Maine will update this story when more information becomes available.

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