Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of HealthNow's Compliance with Medicare+Choice Prompt Payment Regulations During the Period August 1, 2003 through January 31, 2004," (A-02-04-01016)

November 12, 2004


Complete Text of Report is available in PDF format (244 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

The objective of this review was to determine whether HealthNow New York, Inc.ís Senior Blue Health Plan (HealthNow) complied with prompt payment regulations to timely pay or deny claims submitted by noncontracted providers.  HealthNow substantially complied with Federal prompt payment regulations for claims submitted by noncontracted providers and paid over 95 percent of clean claims within 30 days of receipt.  However, HealthNow did not pay or deny some claims within 60 days of receipt.  We recommended that  HealthNow ensure that all claims are paid or denied within 60 days of receipt.  HealthNow concurred with our findings and recommendations.