Lawmakers Question Delays In State Medicaid Payments

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Legislators raised questions Wednesday about problems with the state's new $17.3 million Medicaid computer system that have delayed claim payments, creating financial hardships for some doctors and other medical providers.

Members of the lawmakers' Interim Finance Committee grilled Chuck Duarte, head of the state Division of Health Care Financing and Policy; and Teresa DiMarco of First Health Services Corp., which is now handling the payment claims - including a backlog claim total of nearly $100 million.

Assemblywoman Kathy McClain, D-Las Vegas, asked why the state's new computer program, set up to process the claims, bogged down given the fact that First Health Services has been involved in similar programs in 23 other states.

DiMarco said the main difference in Nevada was a short time frame in which to set up the program. She said Nevada had only a year to get its system going and other states had up to two years to do the same thing.

Duarte said his agency had no backup contingency plan to fall back on, because its previous contractor had left and the old state computer program was scrapped in favor of the new system.

Assembly Speaker Richard Perkins, D-Henderson, said the big problem with payment delays is that some health care providers may drop out of the Medicaid program. That would hurt people who rely on Medicaid as their "last line of opportunity," he added.

Duarte said his agency staffers have been "tapped to an extreme level" to help First Health Services catch up with the payments. And DiMarco said the goal is to have "a stable environment" on claim payments by April.

Assembly Minority Leader Lynn Hettrick, R-Gardnerville, said he recently met with health care providers who told him their claims had to be reprocessed "again and again and again" because of a flawed method of reviewing the payment codes on their bills.

"Don't get them so frustrated and angry that they're going to quit being Medicaid providers and a few are going to go broke," he warned.

Sen. Bernice Mathews, D-Reno, said she had been told of problems such as misinformation and medical providers having to hold on the phone for up to half an hour after calling First Health Services for help.

DiMarco said her company, based in Glen Allen, Va., has added staffers to reduce the phone waits, and increased staffing because of the "very steep learning curve" that resulted from not being able to rely on the knowledge of the state's previous contractor.

Duarte noted the company was given a 30-day notice on Jan. 5 to fix the various problems. Penalties can be assessed if the company fails to comply.