Review of Compliance with Medicare + Choice Prompt Payment Regulations - America's Health Choice Medical Plans, Inc.

EXECUTIVE SUMMARY:

The objective of this audit was to determine whether America's Health Choice Medical Plans, Inc. (America's Health Choice) complied with M+C prompt payment regulations to timely pay or deny claims submitted by noncontracted providers. America's Health Choice did not comply with Federal prompt payment regulations. Specifically, it did not:  (1) pay at least 95 percent of clean claims within 30 days of receipt, (2) calculate and pay interest on clean claims not paid within 30 days of receipt, and (3) pay or deny all claims within 60 days of receipt. As a result, some noncontracted providers were not paid timely and accurately. We recommended management of America's Health Choice establish internal monitoring to ensure its policies and procedures are properly implemented.