BCBS of North Dakota slapped with fine for claim denials

Blue Cross Blue Shield of North Dakota will pay a $125,000 fine after a yearlong investigation found deficiencies in how the health insurer processes mental health and substance abuse claims.

North Dakota Insurance Commissioner Jon Godfread said July 9 that BCBS of North Dakota violated parity laws concerning mental and substance abuse claims. Mr. Godfread added that BCBS of North Dakota had deficient preauthorization processes and violated laws pertaining to telehealth services coverage, independent external review assignment and procedures, policy form filing, and other issues.

In addition to the fine, BCBS of North Dakota will invest more than $300,000 to address the issues identified by the state.

Tim Huckle, BCBS of North Dakota president and CEO, said in a prepared statement: "As with every examination, Blue Cross Blue Shield of North Dakota appreciates the opportunity to learn about the ways we can enhance our internal operations in this evolving environment. The health insurance industry continues to grow significantly more complex and this review reveals that we can do more to ensure its compliance in this highly regulated environment."

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