Cobb Reporter

Blue Cross Blue Shield is facing a $5 million fine over “serious claims” issues following a lengthy investigation into regulator violations of state laws and agency rules. 

In a recent report, Insurance and Safety Fire Commissioner John King told FOX 5 Atlanta this marks the largest fine in agency history with the potential for additional penalties if certain benchmarks are not met moving forward.

"This examination uncovered a number of serious issues, including improper claims settlement practices, violations of the Prompt Pay Act, failure to reply to consumer complaints in a timely manner, inaccurate provider directories, and significant delays in loading provider contracts," King told FOX 5 Atlanta.

Investigators began their probe after receiving numerous complaints from individuals, doctors, hospitals, and more across Georgia about the insurance carrier's operations, according to the report. 

Officials note the most complained about errors with the carrier were connected to in-network claims processed as out-of-networks and claims that were rejected for unknown reasons. Though Blue Cross Blue Shield tried to replace its provider database system, FOX 5 reports authorities said it failed to promptly investigate or settle claims.

Under the order, Blue Cross Blue Shield must follow a corrective Action Plan and submit a monthly report to officials, the report states. To avoid further penalties, officials told FOX 5 the organization must also develop a new process for handling regulatory provider complaints, pay claims within established timeframes and load provider contracts in a timely manner.