Audit of Keystone Health Plan West Medicare+Choice Program Payments to Noncontracted Providers

EXECUTIVE SUMMARY:

The objective of this audit was to determine whether Keystone Health Plan West (Keystone) complied with Medicare+Choice prompt payment regulations to timely pay or deny claims submitted by noncontracted providers.  Keystone complied with Federal prompt payment regulations to timely pay or deny claims submitted by noncontracted providers.  Specifically, it (1) paid at least 95 percent of clean claims within 30 days of receipt, (2) paid interest on clean claims not paid within 30 days of receipt, and (3) paid or denied claims within 60 days of receipt.