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.
On March 6, 2008, the Court Finally Approved the Highmark Settlement, however an objector filed a notice of appeal of Judge Morenos Order Finally approving the Settlement.
Highmark Settlement Update:
- NEW! Highmark Settlement checks were sent to class members (who did not opt out) of the Highmark/Love Settlement during the week of November 3, 2008. If you have any questions, please call 1-866-486-1725.
- The Highmark/ Mountain State Billing Dispute External Review Board (BDERB) is now available to MDs and DOs who are class members of the Highmark/Love Settlement Agreement.
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
- You must have exhausted all internal Highmark dispute processes
- Your dispute must arise from services provided to Highmark members.
- Billing dispute amount must exceed $500 as a single dispute or multiple disputes within a 1-year period must exceed $500 as an aggregate amount
- You must have initiated a provider billing dispute and received a written response that you wish to have reconsidered
- The internal Highmark dispute process must be concluded on or after September 5, 2008.
- 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 the original denial letter.
- You must submit the proper filing fee.
Billing Dispute Forms and Instructions
- Please note: Due to a typographical error, the AAPP Foundation and the American Psychoanalytic Foundation were inadvertently excluded from the list of charitable organizations list on page 4 of the Claim Form Instructions. If you would like to donate your proceeds from the settlement fund to either of these foundations, please indicate the number for the foundation of your choice on your claim form and the settlement administrator will honor your request.
50. AAPP Foundation
51. American Psychoanalytic Foundation
Highmark Compliance Information
Highmark Court Orders and Settlement Agreement Documents
Highmark Official Mailed Notice and Documents
Highmark Mailed Notice, Claim Forms and Claim Form Instructions were mailed to physicians on November 29, 2007.
The Highmark Settlement Forms have now been mailed to physicians. The documents include the Notice, Claims form and Claims Instruction, as well as an insert. If you did not receive the form, simply print the documents below and return them. Claims should be postmarked no later than February 27, 2008 and sent to the Settlement Administrator at: Highmark/Mountain State, Settlement Administrator, PO Box 3775, Portland, OR 97208-3775.