@NCCapitol

@NCCapitol

DHHS cutting checks for frustrated Medicaid providers

Posted July 24, 2013

N.C. Department of Health and Human Services

— Three weeks after the state implemented a new system for handling Medicaid claims, the Department of Health and Human Services has started to cut checks for exasperated providers who complain that they aren't being paid for services provided.

The NCTracks system replaced a decades-old Medicaid claims system, and providers have said it is now more cumbersome to file claims and that reimbursements aren't being received.

Joe Cooper, chief information officer for DHHS, said Wednesday that the agency is temporarily waiving its requirement that all reimbursements be made electronically so that providers having trouble with the electronic transfers can get paid and officials can correct any mistakes in routing electronic payments.

"We're going to send paper checks to them and give them another week or so to get the EFT number correct," Cooper said. "This is about a week's process."

There was no immediate word on how many claims are pending and how much cutting the checks will cost the state.

Cooper said NCTracks has successfully handled more than 13 million claims already, paying out more than $470 million.

"We're making great progress," he said. "We have a team of people that are calling every day to providers that are having issues (with filing claims)."

T'jana Love, who works at Woodhaven Rest Home in Enfield, said she hasn't been paid since July 7, and the facility blames the payroll delay on NCTracks.

Medicaid payment problems squeeze employees of health providers Medicaid payment problems squeeze employees of health providers

"Because of this new system, it is very doubtful that Woodhaven will receive any Medicaid reimbursement for any of the clients we serve," operators said in a July 17 memo to employees. "If this happens, Woodhaven would have to delay payroll until Medicaid payments are received by the state."

Cooper said Woodhaven is among the providers who haven't set up an account properly to accept electronic reimbursements. Although staff has been added and hours extended at the call center, the average wait time remains more than 30 minutes.

"We're going provider by provider, listening to their issues and addressing them," he said. "We get them on the phone, and we work through them. Then, it's usually pretty straightforward getting their problems resolved."

DHHS officials said Woodhaven's problem has been resolved, but Cooper recommended that providers in a similar position work with customer service at NCTracks to resolve payment problems.

"We said (it would take) 30 to 90 days to work through this, and it will be 30 to 90 days," he said. "Other states have taken a year."

Meanwhile, Love said she cannot walk out on her patients, even if it means difficulty making ends meet.

"My brain is telling me to leave, but my heart says stay. So, I got to go with my heart," she said. "I'll have to borrow money to pay my bill. If not, my lights will be cut out on the 29th."

13 Comments

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  • LuvLivingInCary Jul 24, 2013

    in other words the new system failed and we have to manually pay them money. wrap needs to did in to this. email me.

  • noel Jul 24, 2013

    zLikeSundayMorning - "Seems the company and employee were hanging by a thread to start with. Do they have any non-Medicaid patients?"

    Contrary to some comments about providers refusing Medicaid, there are MANY providers that have a very high volume of Medicaid patients. Adult care homes, some nursing home, personal care services and some other providers often have a very high % of Medicaid patients. If they have absolutely no $ coming in it could put them in a bad position.

  • noel Jul 24, 2013

    maryfew1 - "Just FYI, as of a week ago all claims that pend for nurse review can't be approved. The system will allow the nurses to deny but it will not allow them to approve cases. I'm pretty sure the state is unaware of this problem but it is NOT a priority for fix by CSC. It was a known issue from day 1. Also, b/c the previous system was so old and not updated, lots of cases (hundreds) are pending incorrectly, again not a priority for a fix. Also, b/c the previous system was so old and not updated, lots of cases (hundreds) are pending incorrectly, again not a priority for a fix."
    How on earth is the state unaware that claims requiring a nurse review could not be approved? Also, why does the age of the prior system cause icorrectly pending claims under the current system?

  • DontVote4LiarsCheatsOrThieves Jul 24, 2013

    sunshine1040 - "I repeat my self what good is having health insurance if their are no health care providers that will accept it. But it seems the majority not only voted for this man once but TWO times"

    AMEN!!!

    Shows the majority of the voters of this country probably don't have the sense it would take to find their way out of a wet paper sack.

    The majority often vote for proven liars and cheats, and sometimes convicted thieves and druggies.

    Makes one wonder what it's going to take for them to get some sense.

    But makes it easy to understand what's gone wrong with this country.

  • sunshine1040 Jul 24, 2013

    I repeat my self what good is having health insurance if their are no health care providers that will accept it. But it seems the majority not only voted for this man once but TWO times

  • DontVote4LiarsCheatsOrThieves Jul 24, 2013

    This is why so many providers don't accept Medicare and Medicaid patients.

    If we can't get them to accept that because of messes like this, along with the low amounts they get paid for providing these services to Medicare and Medicaid patients when they could be spending that time instead with full pay patients, how is Obama going to get them to accept Obamacare patients?

    It ain't a'gonna work!!!

  • lsdhome Jul 24, 2013

    Fix it, Pat!

  • ezLikeSundayMorning Jul 24, 2013

    Obviously the system needs to work, but employees not paid since July 7th?! Lights will be cut off on the 29th?! Seems the company and employee were hanging by a thread to start with. Do they have any non-Medicaid patients?

  • foodstamptrader Jul 24, 2013

    "Not expanding medicaid is the " nail in the coffin " for McCrory." - billsmith98

    LOL!!! Yes, the current Medicaid program runs like a well oiled machine. McCrory should definitely expand it so we can waste more taxpayer money. Smh....

  • maryfew1 Jul 24, 2013

    Just FYI, as of a week ago all claims that pend for nurse review can't be approved. The system will allow the nurses to deny but it will not allow them to approve cases. I'm pretty sure the state is unaware of this problem but it is NOT a priority for fix by CSC. It was a known issue from day 1. Also, b/c the previous system was so old and not updated, lots of cases (hundreds) are pending incorrectly, again not a priority for a fix.

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