Regence May Face Audit

July 21, 2010 -- Regence BlueCross BlueShield of Oregon could face an audit by the Public Employees Benefit Board, which oversees healthcare services for state employees and their dependents.

 

Regence held the fully-insured contract for 24 years, which ended in 2010. Since then, the board has contracted with Providence Health Plans under a self-insurance agreement. State employees can also choose Kaiser Health Plan.

 

Joan Kapowich, PEBB’s administrator, intends to look into the cost of having an audit conducted by Mercer. Once she has that information, she’ll consult with the board, which will make the final decision. If an audit does proceed, it’s too early to know which time period would be evaluated.   

 

Mercer has just completed an audit of Samaritan Health Services, evaluating the accuracy of claims submitted after its contract with PEBB ended in January 2009. Throughout that year and in 2010, Samaritan continued to process 43,000 claims that amounted to $12.4 million.

 

“The claims people at Samaritan were very cooperative during the process,” Ralph Trieselmann, CEBS, CLU, with Mercer, told the board on July 20. “There wasn’t a feeling they were trying to hide anything.”

 

Samaritan passed with flying colors and, in fact, exceeded common industry standard practices. In terms of claims processing accuracy, it scored 98 percent. For financial payment accuracy (the amount of paid dollars processed), it reached 99 percent. 

 

Rocky King, the policy advisor on health reform in the Consumer and Business Services Department, suggested the board do an audit of Regence, looking, for example, at claims paid data. 

 

“I always felt there was more scrutiny to that little self-insured contract,” King said. “Much more so than to Regence -- a fully insured plan. The expectations were different.”

 

 

To take a look at the complete audit report of Samaritan Health Services, click here.