Problems with the state’s new $17.3 million Medicaid computer system have delayed the payment of claims, creating financial hardships for some doctors and other medical providers.
The state Division of Health Care Financing and Policy, which oversees the Medicaid program, and its new vendor, First Health Services Corp. of Glen Allen, Va., are working to fix the problems as quickly as possible, Administrator Charles Duarte said.
“We are disappointed in the time it has taken to resolve these issues,” Duarte said. “We are staying on top of the vendor to make sure the system meets the performance standards required as soon as possible.”
Stephanie Finkelstein, director of operations of the Ambulatory Surgery Division of HCA in Nevada, said the problem has delayed payment of claims worth nearly $250,000.
“We provide major pediatric dental care for underserved kids who are already being denied access to health care,” Finkelstein said. “We may not be able to continue to offer those services given the current situation.”
Finkelstein said that at one company site where Medicaid surgeries are performed, only 98 of 353 claims have been paid. At a second facility, 30 of 133 claims have been paid.
“When we submit claims, initially they are all denied” or being decided, she said of the health care program for the poor. “Every claim must be followed up two or three times. When we follow them up, we get inconsistent information.”
When informed of the upcoming change this fall, Finkelstein said she asked whether the system would work properly.
“I was assured it had been tested and that it would work,” she said.
Dr. John Nowins, president of the Clark County OB-GYN Society, said tens of thousands of Medicaid claims from pediatric dentists, surgery centers, pharmacies, hospitals and others providing medical care to the underserved remain unpaid.
“It’s a situation where the underserved are expecting these services to be available, but the system isn’t working right,” he said. “It’s not good.”
Nowins said the Clark County Medical Society has received 160 complaints from doctors about the claims problems.
The medical society is compiling information about the claim payment problems to present to state lawmakers, who authorized funds for the purchase of the new system in 2001.
Nowins said the state initially said there was no problem. Now more than three months have gone by and an admission has been made, but downplayed.
“They say there is a computer glitch,” he said. “I don’t know what that is. All I know is, if I don’t pay my phone bill, my phone service gets cut off.”
“We’re in a situation where tens of thousands of claims are not getting paid,” Nowins said. “To me, that’s a big deal.”
The problems began when the new system was brought online Sept. 30.
Duarte said the company was given a 30-day notice on Jan. 5 to fix the problems. Penalties can be assessed if the company fails to comply.
The company has devoted more staff to fixing the problems, as has the state Medicaid agency, he said. The extra work by the vendor will not cost the state or taxpayers, Duarte said.
Duarte said the payment of claims is improving daily.
“Cash flow is king for a lot of small providers,” he said.
The agency has provided a credit mechanism to those facing cash flow problems, but not all medical providers can easily take advantage of it, Duarte said.
The new system was mandated by the federal government. Nevada had been the only state in the nation without a federally certified system.
Duarte said the state has not yet sought federal certification for its new system, which takes six months once initiated. Once certified, the state will be eligible for reimbursement from the federal government for 90 percent of the cost of the system, plus 75 percent of the ongoing operating costs.