Medicare: Performance of Blue Shield of Massachusetts under the Tri-State Contract

摘要

In separate letters the New Hampshire, Vermont, and Maine congressional delegations cited numerous beneficiary and provider complaints relating to the quality of Medicare services. In these letters you asked us to review the performance of Blue Shield of Massachusetts as the Medicare Part B carrier for those three states. As agreed with your offices, we compared Blue Shield's performance with certain contract requirements for six areas: timeliness of claims payment, payment accuracy, telephone service, reviews of denied claims, responses to written inquiries, and requests for information already provided. We did our work at Blue Shield's corporate offices in Boston, Massachusetts, and at its Medicare Part B tri-state claims processing center in Biddeford, Maine. We also performed work at Health Care Financing Administration(HCFA's) regional office in Boston. We analyzed Blue Shield reports showing its performance under the tri-state contract and examined HCFA's evaluations of Blue Shield's performance. We also performed tests to validate certain data that Blue Shield reports to HCFA.