Agencies that provide behavioral health services in Lincoln and Southeast Nebraska say the conversion by the state to three health care companies rather than one for managed care has given them their own management headache.Ìý
On Jan. 1, three companies -- United Healthcare, Nebraska Total Care, and WellCare of Nebraska -- took over managed care for Medicaid clients, called Heritage Health, each one able to provide integrated services for medical, behavioral health and pharmacy.Ìý
What that means for agencies is having to file claims with three companies, depending on the enrollment of clients, who do things three different ways, said Jon Day of Blue Valley Behavioral Health, a private nonprofit organization that provides outpatient behavioral health services in 16 rural counties in Southeast Nebraska.
Authorizations for medications? Three different ways. Enrollment and certification of counselors and other mental health workers? Three different ways. Claims for residential services? Three ways.
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One company is underpaying the agencies' claims, Day said. Or claims have to be resubmitted several times.
Some agencies have racked up unpaid claims over a two-month period of well over $100,000.
"You only have so many resources, and so your staff has to end up doing three times the work," he said.
The reimbursement for services is slow, and some agencies are way behind getting paid for the claims they've submitted.
Topher Hansen, CEO of CenterPointe, said his agency has been trying to contract with all three managed care companies since October, but as of the end of February he had a contract with only one of the three.
For selected services, different companies are paying at highly reduced rates. They've also asked the agencies to submit claims to commercial insurers for Medicaid services, which the commercial insurers never have covered.
"It's just making us go through a ridiculous process that's going to end up taking time and back in the same place and submitting our bills to the (managed care companies)," Hansen said. "I cannot for my life understand why they're making us do this."
On claims for residential care to one of the companies, he said, CenterPointe hasn't been able to figure out how to submit them in a format the company will accept.
"And we work at this. I mean, we want this to smooth out. We've got to get our bills paid, and we need the money to do it," he said.
State Medicaid Director Calder Lynch said Monday that generally the implementation of the new managed care program has gone well. He acknowledged it has become more complex for mental health providers to work with three managed care companies, rather than one.
"We're working with them on a daily to weekly basis to address issues that are arising," Lynch said.
For some agencies that are struggling with the new claims processes, the managed care companies are providing cash advances when necessary.
The companies, collectively, have made about $10 million in payments for behavioral health services since Jan. 1, he said.
"But I do think that there probably are some providers who are being disproportionately impacted for a variety of reasons," Lynch said.Ìý
The companies are working individually with them, he said. And the state has made some adjustments to fee and service schedules, and claims will be reprocessed.
The state last week published an advisory telling the managed care companies which claims should not first require a denial by a commercial insurer.
Lynch said he believes it's just a handful of providers having problems.
"It's not to discount the importance of addressing it and getting it fixed," he said, "but I'm very confident we're going to work through these issues and things will be in stable operations very quickly."
It's important, he said, that clients have choice, and that they can get services that treat the whole person -- mental and physical health.
Jon Day said Monday some problems had improved, but only because of the hard, hard work agencies are doing, talking to the companies several times a week. And even with that, some problems are not resolved, he said.
"We bring our A-game," he said. "We bring our A-plus A-game. ... We should not have to be struggling this hard."
And the cash advances Lynch said companies are offering up?
"I've never heard that before," Day said. "That hasn't been offered to us yet. ... If they need (to offer) cash advances, tell me how messed up that is."
It's not just a handful of agencies, Day said. It's practically all of them.
There has to be better accountability, because just saying it's going to get better isn't enough, he said. The managed care companies should be penalized if they don't start making their benchmarks.