Care providers fault state system
Friday, August 7, 2009 10:01 AM PDT
SALEM (AP) — Oregon state officials and care providers are agreeing on one thing: a new state computer system that handles 2 million state Health Plan payment claims each month has serious glitches.
State officials say low-income Oregonians who qualify for state-paid care are still able to see doctors and get prescriptions filled. However, care providers say the state’s Medicaid Management Information System has turned into a monthslong nightmare.
‘’What we’re saying is: fix the problem,’’ said Paul Phillips, who represents nine managed health care organizations that call themselves the Coalition for a Healthy Oregon.
The new Medicaid billing system went online Dec. 9, after being delayed twice. Problems with the $80 million system became apparent almost immediately.
The system processes $200 million worth of claims each month. Given that scope, officials at the state Department of Human Services said they expected glitches.
Still, the department is running out of patience.
Last month, Clyde Saiki, Human Services deputy director, hand-delivered a letter demanding that the contractor, Electronic Data Systems, fix the problems within 90 days or the state could file suit.
“It’s a frustration for us,’’ Saiki told The Oregonian on Thursday. “The letter isn’t the first we’ve sent to them. There’s been a series of letters we’ve sent over six months.’’
Electronic Data Systems has not yet responded to the state’s July 21 warning letter. But a spokesman said Thursday that the company has a plan to resolve the remaining issues as soon as possible.
“By their very nature, MMIS systems are extremely complex computer networks, customized to each state’s needs,’’ said Bill Ritz, an Electronic Data Systems spokesman.
The federal government is shouldering 90 percent of the cost of the system upgrade. But neither state officials nor health care providers say they know how much errors have cost them or state government.
Some problems: the system isn’t clear on whether a patient is enrolled in a specific program or eligible for services at all; some managed health care organizations complain about having to enter data manually.
“For us, it’s meant difficulty getting proper enrollment information for individuals,’’ said Kevin Campbell, chief executive officer of Greater Oregon Behavioral Health Inc.
Campbell’s managed care organization provides mental health treatment in 14 Oregon counties.
“You can check in the morning, and it would say: ‘Yes, they’re enrolled’ and by afternoon it would say: ‘They’re not’,’’ Campbell said. “What it results in is us taking a big risk by providing services to people who may ultimately be determined ineligible.’’
Jeff Heatherington, president of FamilyCare Inc., says his managed care organization has paid pharmacy and emergency room bills for patients who may not even be enrolled in the program. FamilyCare provides physical and mental health treatment for about 22,000 patients. For months, Heatherington said, the system was not assigning some new patients who should have gone to FamilyCare.
The providers also say they’re worried about how the system will handle an additional 80,000 children and 35,000 low-income adults who will become eligible when the Oregon Health Plan is expanded this fall.
Saiki said the system has the capacity to absorb the additional clients.
‘’Things have improved,’’ he said. ‘’It’s just that they’re not improving fast enough.’’
