MaineCare glitch gets response Providers awaiting payment should soon be ‘pretty much up to date’

AUGUSTA – Progress was made this week in getting money to MaineCare providers whose payments have been stalled since January in a bureaucratic computer snarl.

By the end of next week, according to Christine Gianopoulos, acting director of the Bureau of Medical Services, all MaineCare providers owed $1,000 or more should have received a payment equal to either two or three times their average weekly filing.

Those providers who file claims electronically should see deposits in their accounts on Tuesday, and those who file on paper should receive checks in the mail by Thursday or Friday, she said. After that, interim payments will be mailed regularly on a two-week cycle to providers whose claims are not being processed correctly by the bureau’s new computer system.

“That should get everybody pretty much up to date,” Gianopoulos said.

Gianopoulos noted that $35.8 million in lump-sum interim payments was processed this week, in addition to about $13.3 million that the system paid as it should. The department typically handles $31 million in claims each week.

Thousands of MaineCare providers have been without payment since January, the unintended consequence of the state’s decision to bring a new computer system on line in order to process claims in compliance with federal health care billing regulations. Flaws in the system caused it to reject the majority of the approximately 125,000 claims the state receives each week, without notifying either providers or bureau staff. By the time it became clear the system wasn’t working as it should, claims had backed up and many providers reportedly were borrowing money to stay in business or threatening to close their doors. Bureau support staff was overwhelmed with questions and complaints.

On Tuesday of this week, Gov. John Baldacci instructed Jack Nicholas, commissioner of the Department of Health and Human Services, to come up with a plan to resolve the chaotic mess within 30 days, “no ands, ifs or buts.” Wednesday afternoon, Nicholas presented an ambitious plan to fix the problem while ensuring regular payments to providers in the interim.

Nicholas’ plan, developed in conjunction with Gianopoulos and other staff as well as outside consultants, includes measures to repair the flaws in the computer program, provide additional training to bureau workers and contracted providers, and bring in a new project manager and additional support staff. Goals include increasing the number of claims that are successfully processed through the new computer program by 5 percent each week while working closely with the president of CNSI-Solutions, the Maryland-based company that provided the program and with staff from the federal Centers for Medicare and Medicaid Services.

DHHS will report to the Legislature and the governor each Friday on its progress. This week, according to the report released Friday afternoon:

. The number of providers whose claims were processed and paid by the new computer system increased from 1,286 to 1,292, an increase of 0.5 percent.

. The number of claims processed and paid by the system decreased from 53,708 to 24,580, a decrease of 54 percent.

. The amount paid increased from $12,126,858 to about $13.3 million, an increase of about 10 percent. (The report notes that fewer providers filed this week, but the dollar amount paid out was higher because many claims were from nursing homes and other large-scale facilities.)

. The number of providers scheduled to receive interim payments rose from 685 to 2,082, and the amount paid in interim payments increased from $10,026,203 to $35,800,000.

A schedule of training and informational meetings will be mailed to providers on Monday. By the end of next week, additional staff will be available to answer provider inquiries and a new lead consultant will be in place, according to the report.

Gov. Baldacci said Friday that he is satisfied that progress is being made toward his 30-day deadline, but emphasized that he will hold Nicholas and his staff accountable for fixing the problem.