Experienced delays in your BCBS/HMO payments? We have answers!

BCBS LogoIn recent weeks, many clinicians have reported delays in receiving payments from Blue Cross Blue Shield (BCBS) HMO plans. Calls to BCBS left several clinicians with even more questions — from the cause of the delays to exactly when they might expect  to see payment.

Our union, CliniciansUNITED / SEIU Local 509, reached out to our contacts at Blue Cross to get to the bottom of this weeks-long delay, and the insurer issued a Managed Care Behavioral Health Provider Update (see below).


A 2016 calendar year system enhancement to automate the processing of Managed Care Behavioral Health services is in the final implementation stage. The change will improve the accuracy and timeliness of Managed Care Behavioral Health claims in support of the first 12 visits not requiring authorization.

Managed Care claims for dates of service after 1/1/16 will be released by the end of February. There is no impact to PPO Behavioral Health Claims.

Based on what we’ve learned, CliniciansUNITED expects the final pieces of this ‘system enhancement’ to be implemented by the end of February — so providers should see payments no later than the beginning of March. Some clinicians may see reimbursements as early as this week.

As many clinicians have pointed out, some claims will have passed the 45-day statutory limit by the time everything is sorted out. We have ensured that Blue Cross Blue Shield is aware of statutory requirements to pay interest on these claims.

While we now have answers and a firm timeline, there is still work to do. We will need to hold BCBS accountable to its stated deadlines — and we will work to make sure every clinician receives any interest owed. 

Click here if you have faced challenges with Blue Cross Blue Shield HMO claims in recent weeks.

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