News & Analysis as of

Anthem Blue Cross Fraud

Davis Wright Tremaine LLP

Anthem's New Chargemaster-Based Claim Edits: Which Charges and Providers Will Anthem's New Process Target and How Will It Impact...

Effective August 1, 2025, Anthem will implement a new claims-editing process that adjusts payments for Medicare Advantage (MA) claims based on an undisclosed, customized chargemaster table. The announcement identifies claims...more

Haight Brown & Bonesteel LLP

Healthcare Claim Administrator’s Authorization of Services While Failing to Disclose Alcohol-Related Exclusion Supports Action for...

In Tenet Healthsystem Desert v. Blue Cross of California (No. D069057, filed 3/17/16), a California Court of Appeal held that a hospital was not limited to simply collecting on its bills, but could state causes of action...more

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