November 08, 2024
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MaineCare forum yields complaints Bureau of Medical Services says system now processing claims correctly

BANGOR – The state’s Bureau of Medical Services says 95 percent of newly submitted MaineCare claims now are being processed correctly. An interactive voice-response telephone service that has been problematic now is working as it should, allowing providers to check on the status of their claims. And a cadre of new support staff will be brought on board April 1 to help the state agency answer providers’ questions.

Still, at a special outreach meeting for disgruntled MaineCare providers Monday morning in Bangor, staff from the state agency got an earful about the impact of the state’s new computer billing system on their practices.

MaineCare is the state’s name for its Medicaid program, which provides health care and other services to about 262,000 low-income Mainers.

About 70 people showed up at the first of several statewide forums scheduled for this week to help MaineCare providers cope with the dysfunctional new billing system that has left most of them without regular payments since January. Though many attending Monday’s meeting said they had only heard about the outreach event at the last minute – through word of mouth or by reading about it in a weekend story in the Bangor Daily News – the crowd overflowed a stuffy conference room at the Department of Health and Human Services center on Griffin Road and had to be moved across the street to a space hastily set up at the Spectacular Event Center.

After giving a brief update on the status of the system repair, a panel of four bureau specialists took general questions and comments from those providers in attendance.

Providers told the bureau staff that they are not receiving the regular, predictable interim payments promised in recent weeks by Jack Nicholas, Health and Human Services commissioner. Some said the payments they do receive are insufficient, and others said they still are unable to get timely answers to their questions from support staff at the bureau. Several reiterated concerns that the interim payments being sent to providers, while helpful in making ends meet until the state’s new computer system is working correctly, are setting up a serious bookkeeping problem for the future.

Frank Evans, comptroller for Protea Behavioral Health Services, which has offices throughout the state, told the bureau staff that his agency is waiting for “probably a million dollars” in unpaid claims. Despite the state’s reassurances over the past few weeks that progress is being made, “We’re still not having any success,” Evans said. “We’ve left voice mails and e-mails … we’ve been told the problem is fixed … we’re not even getting any verification that our claims have been received.”

Evans said Protea has received some interim payments while waiting for the new system to get up to speed, but each payment has been $20,000 to $30,000 short of the approximately $150,000 the agency bills in an average week. Because Protea handles billing for many other agencies as well as its own mental health services, the confusion and constricted cash flow is affecting about 200 providers, he said.

Several billing experts in the audience had specific questions regarding how to file MaineCare claims so as not to have them rejected by the finicky new computer program. Provider relations specialist Michelle Quintal said the majority of new claims now are being processed as they should be, but that even with all information entered correctly and the system working properly, it still may take two to three weeks for a claim to be paid. Providers who file electronically should receive an acknowledgement that their claim has been accepted for processing, she said.

Once the system is up to speed and working reliably, the state plans to start adjusting provider payments to make up for any overpayments or underpayments made through the interim payment system. Several providers at the Monday forum emphasized that because the interim payments aren’t tied to specific services, it will be difficult and costly to reconcile providers’ books with bureau records once the adjustment period begins.

After the meeting, Mike Norton, spokesman for the Department of Health and Human Services, said notification about the provider forums was not sent out via e-mail and U.S. mail until Friday, so many Bangor providers might not have gotten the word. Because the first of the forums still drew such a crowd, he was hopeful that other meetings this week will be similarly well-attended.

Norton said the state will work with professional associations to better understand the specific accounting problems growing out of the management of the interim payments. “We won’t be able to work directly with every provider’s back-office staff,” he cautioned, “but we will probably be able to do something.”

“People don’t have a lot of confidence in us right now,” Norton said. “Before this happened, we were pretty good, reliable payers, and we will be again. … It’s regrettable that we’ve put our providers in this position, but now that we’ve done it, the best we can do is work together to get beyond it.”


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