- Associated Press - Wednesday, May 6, 2015

HARRISBURG, Pa. (AP) - The health insurer Highmark has agreed to pay about 30,000 outstanding medical claims filed by rival UPMC providers.

Gov. Tom Wolf announced the development Wednesday and commended Highmark for working with his administration to resolve the outstanding claims as the two western Pennsylvania health care giants compete for patients and coverage.

Since Jan. 1, nearly all of the more than 900,000 insurance claims filed on behalf of Highmark subscribers who were treated by UPMC providers have been paid, but 30,000 were held up by the ongoing dispute between the two companies.

Calling the agreement “a major win for consumers,” Wolf said Highmark agreed to consider the claims as in-network so that patients will not be billed for the services.

“My focus is protecting consumers caught in the dispute between Highmark and UPMC, and I have urged both companies to do the same,” the Democrat said.

Highmark declined to disclose the monetary amount of the claims. Spokesman David Carter said the dispute involved “relatively few” claims and suggested that UPMC held up the processing by not providing needed information.

UPMC spokesman Paul Wood thanked Wolf and acting Insurance Commissioner Teresa Miller for resolving the disputed claims.

Highmark is seeking state approval to transfer $175 million from its $5 billion-plus insurance reserves in the form of grants that would finance capital improvements and improve cash flow in its eight-hospital Allegheny Health Network.

Last month, Wolf and state Attorney General Kathleen Kane petitioned Commonwealth Court to force the companies into arbitration after UPMC threatened to deny in-network access to its hospitals and doctors for 180,000 seniors.

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