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Medicaid Workers To Receive Payments

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By LINDSAY PETERSON

The Tampa Tribune

Published: July 25, 2008

The state is making emergency payments to thousands of Medicaid providers who haven't been reimbursed in nearly a month because of glitches in a new computer system.

The problems with the system, however, haven't been fixed.

Hundreds of thousands of poor and disabled people in Florida depend on Medicaid for health care services. That includes about 30,000 who rely on the payments to pay for personal care at home.

"It's a scary situation when chaos is being created by the system that is supposed to support these individuals," said Dianna McCullough of Wimauma, who receives Medicaid money to pay for home care for her son. "People need to get their pay."

The spokesman for the state Agency for Health Care Administration, Doc Kokol, said that the computer problems have not affected care, but McCullough wondered how long that would last if the computer problems continue.

"You talk about a difficult job. You talk about a job nobody wants," she said. "People can only put up with so much."

Kokol said that system engineers are dealing with the problems as they arise and fixing them as fast as they can. In the meantime, the agency is sending money to providers to tide them over until their claims can be processed properly.

So far, the agency has processed emergency payments for 5,600 providers who have reported problems. It plans to send payments to an additional 3,000 to 4,000 this week.

Because of the glitches, the health care agency doesn't know precisely what it owes many of these providers, so it is paying them about 90 percent of a typical monthly claim.

The agency said that since the computer system began operation on June 26, the state has processed nearly $590 million in claims from 45,000 of the state's 100,000 providers.

Lucia Topp of Rubonia helps take care of McCullough's son and hasn't been paid since mid-June, she said. But this week, a health care agency representative called to say that $2,200 would be deposited to her bank account today.

"It's not what they owe me but it will help," Topp said. She doesn't know when she will get the rest of the money she's due, about $500. "They said maybe next week. But I don't know. I'm still having problems with the system."

The state hired Electronic Data Systems of Plano, Texas, three years ago to develop the new system. It's highly complex, involving the conversion of 5 million lines of code from the old system, Kokol said. It cost the state $308 million.

The problems showed up as soon as people began submitting their claims last month. The state health care agency hasn't identified which providers have had problems, but the most seriously affected seem to be those with what is known as the Medicaid Waiver program. Its purpose is to keep disabled people out of nursing homes.

The providers described a variety of complications. After filling out a claim and trying to submit it on the computer, many were told they didn't have billing authorization or their client wasn't eligible for Medicaid. Often, when the claim was accepted and they tried to open it later, they were told it did not exist. Then, if they tried to resubmit the claim, it was rejected as a duplicate.

Providers who tried to call an EDS help line were put on hold for more than half an hour, only to get a recording saying no one could help them because of the high volume of calls.

"I waited an hour and a half," said Diana Faris of Punta Gorda. "They transferred me a couple of times, then I got the recorded message about the volume of calls. They were no help."

Kokol didn't go into detail about what was causing the problems, beyond saying that the new system was extremely complex and not easy for someone who was unfamiliar with it.

"In a general sense, some of the challenge is that the screens are very different," he said. Also, providers may have needed new identification numbers and not gotten them.

"That's not to say there have not been issues and challenges with individual system edits that need to be made," Kokol said. "This is such a massive changeover, you try as best you can to get everything perfect. When you don't, you fix it and move on."

He said that EDS has doubled the number of phone lines so people who need help won't have so much trouble calling in. Also, the hours have been extended. People can call in from 7 a.m. to 8 p.m. weekdays and from 10 a.m. to 4 p.m. Saturdays.

He said the agency is in the process of developing an online seminar to explain some of the more complex aspects of the new system and how to deal with problems. Providers who need immediate payments should contact the health care agency's office in their region.

Reporter Lindsay Peterson can be reached at (813) 259-7834 or lpeterson@tampatrib.com.

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