HIGHMARKANA SETTLEMENT INFORMATION

On October 19, 2007, Highmark Inc., and Highmark West Virginia, Inc. d/b/a Mountain State Blue Cross and Blue Shield (“Highmark), entered into a Settlement Agreement with physicians. The settling parties filed their Joint Motion for Preliminary Approval of Settlement on October 23, 2007; the court issued its preliminary approval order on November 19, 2007.

Highmark Settlement Updates:

November, 2008: The Highmark/ Mountain State Billing Dispute External Review Board (BDERB) is available to MDs and DOs who are class members (and did not opt out) of the Highmark/Love Settlement.

The BDERB is a national independent review organization contracted to review billing disputes submitted by an MD or DO. You do not have to participate with Highmark Blue Shield to submit a billing dispute to BDERB; however, your billing dispute must arise from services provided to Highmark members.

Requirements To Dispute A Highmark Decision Using the BDERB:

• You must be a class member of the Love Settlement Agreement who did not opt out.

• You must have exhausted all internal Highmark billing dispute processes (including all appeals).

• Your dispute must arise from denial of payment for services provided to Highmark members.

• Billing dispute amount must:

a) exceed $500 in denied payments as a single dispute; OR

b) be multiple disputes filed within a 1-year period from the filing of the original billing dispute must exceed $500 as an aggregate amount (for more information about this process, see section 7.10(c) of the Settlement Agreement – visit http://www.hmosettlements.com/pages/highmark.html for Settlement Agreement).

• You must have initiated a provider billing dispute with your Highmark Plan and received a written response that you wish to have reconsidered.

• The dispute must be filed within 90 calendar days of the date of the final Highmark denial notification letter.

• You must complete the Highmark Blue Shield Billing Dispute Form and the BDERB Dispute Resolution Agreement listed below for each dispute and return to Highmark with all required documentation including a copy of the original denial notification.

• You must submit the proper filing fee by check. Please note the filing fee will not be charged until the $500 threshold billing dispute amount is reached.

LINKS:
Highmark Blue Shield Billing Dispute Instructions

Highmark Blue Shield Billing Dispute Form

Highmark Blue Shield Billing Dispute Resolution Agreement

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SETTLEMENT DOCUMENTS