Performance of Blue Shield of Massachusetts Under the Tri-State Contract

HRD-88-81BR: Published: Mar 31, 1988. Publicly Released: May 3, 1988.

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In response to a congressional request, GAO provided information on a Medicare carrier's quality of service in Maine, New Hampshire, and Vermont, specifically its: (1) timeliness of claims payment; (2) payment accuracy; (3) telephone service; (4) review of denied claims; (5) responses to written inquiries; and (6) claims records.

GAO found that, in 1987, the contractor: (1) complied with all but one of the contract requirements; (2) met the requirement to process 85.5 percent of all assigned claims in 30 days or less, with performances ranging from 85.5 to 96.3 percent per month; (3) improved its claims payment accuracy to within the specified error rate limits; (4) exceeded the limit for busy telephone lines for beneficiaries in November when it experienced a significant increase in the number of telephone calls; (5) reviewed 98.3 percent of beneficiaries' denied claims within the required 45 calendar days; (6) responded to all beneficiary and provider inquiries within the required 30 days; and (7) complied with the requirement to locate a minimum of 97.5 percent of all claims received.

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