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California regulator investigating Anthem’s claims data for future filings

By Keith L. Martin With one rate hike request reserved due to miscalculations, the California Department of Insurance says it is taking a earlier look at the strength of claims data used by Anthem Blue Cross. Anthem, an auxiliary of WellPoint, withdrew a planned rate hike of up to 39% for some customers after state regulator found miscalculations in its demand.

Noting the error, Anthem said it plans to refile its rate request, which also will take into account medical defeat ratio strategy under lately enacted federal health reform law.
In the interim, California health Insurance Commissioner Steve Poizner said his agency is scrutinizing Anthem’s secretarial and claims systems in regard to the soundtrack and documenting of premiums and claims data, as well as reviewing the company’s information systems and controls. This examination, Poizner’s office said, includes a analysis of Anthem’s paid claims database, premium database and information systems processes and controls. The data analyzed in California’s inquest is used to calculate the company’s medical loss ratio.
In a statement, Poizner said as Anthem prepares its new rate filing, auditors in his department will conclude “whether the original information used by Anthem to prepare these credentials is fair and precise. “This review will examine whether there are troubles with their claims expenditure systems and data controls,” he said. “I will not allow insu

This entry was posted on Friday, May 7th, 2010 at 8:10 am and is filed under Health Insurance. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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