Latest development in Highmark, UPMC battle involves delayed payments

Health insurer Highmark is delaying payment to Pittsburgh-based UPMC for more than 14,000 medical claims due to a dispute over what constitutes in-network care, according to a TribLive report.

Highmark and UPMC executed a consent decree to govern their post-contract relationship. However, the two organizations have failed to agree on what claims satisfy the language in the decree that qualifies Highmark members to receive in-network rates at UPMC facilities, according to the report.

Highmark supports a narrow interpretation of the language in the consent decree, which would limit its members from getting care at UPMC, while the health system has argued for a broad reading of the language, according to the report.

Lynn Seay, a Highmark spokeswoman, told TribLive the insurer is seeking more detailed information from state regulators about when Highmark members can receive in-network rates at UPMC.

More articles on healthcare finance:

Hospitals' uncompensated care costs fell by $7.4B last year
Subsidies are central part of PPACA's success, GAO says


Copyright © 2023 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars