On March 1, 2017, the Colorado Department of Health Care Policy and Financing (HCPF) launched a new fiscal agent and “The Colorado interChange”, a new Medicaid Management Information System for claims payment. HCPF says this new system replaced technology that had been in place for over two decades and will allow implementation of audit recommendations made over the past several years.
The system underwent several hours of testing. In fact, the Department reports there were, overall, more than 200,000 hours of system pilot testing. However, the testing did not apparently catch a list of issues. In many instances, claims are being denied due to system processing errors. Since The Colorado interChange launched, Health First Colorado (Colorado’s Medicaid program) providers have complained of reimbursement problems threatening their financial sustainability and services continuation. The Colorado Department of Health Care Policy and Financing has instituted interim payments to providers who are facing financial difficulties.
From the Desk of Pamela Bisceglia
Interim Director of Advocacy, AdvocacyDenver
Seven months after the launch of this system, claims continue to be denied due to system processing errors. What is unfortunate and hard to forgive is the fact that children and adults with disabilities are caught in the middle. The list of providers that accept Medicaid (public insurance) is short; when a provider closes shop, it is sometimes impossible to find a new provider. HCPF is well aware of the different issues, have held public relation forums and provided a list of links and phone numbers and will always ask for the name or contact information when they get wind of a provider or a client or the client’s family who discuss the issue of nonpayment. Seven months after the launch of this new system, it is reasonable to recommend, request and/or demand that HCPF identify the system and/or human processing errors and provide an exact timeline for resolving these system errors.
In this EVOICE, we examine this issue from three different perspectives. The perspectives reflect the views of: a provider, the State Department that is trying to fix the system and retain providers, and an advocate who fears her clients will lose services.
All interviews by Catherine Strode.
The Executive Director of Behavioral Services of the Rockies, Travis Blevins, contacted AdvocacyDenver to report that he is owed tens of thousands of dollars for services provided to clients across the state of Colorado.
Travis Blevins, Executive Director,
Behavior Services of the Rockies
What services does Behavioral Services of the Rockies (BSOTR) provide?
“We provide applied behavior analysis services for adults and children. We conduct functional assessments of social skills and then we develop plans to help individuals reduce behaviors that are dangerous or affecting their ability to go to a regular school, or the grocery store, or the doctor’s office. We address those behaviors and then teach ways for the child or adult to communicate their needs. We work with school districts, private schools, individuals in their homes. We work across the age range from 20 months to 80 years old and with every diagnosis. We have 119 employees that serve the entire state of Colorado.”
What is the problem for BSOTR right now?
“The immediate problem right now is nonpayment of services we have provided for Early and Periodic Screening, Diagnostic and Treatment (EPSDT). EPSDT is a funding source for assessment, treatment, follow-up, and ongoing services for all children in the state under straight Medicaid not the state waiver. It’s approaching three months that we have not received payment on outstanding invoices for services rendered for children on EPSDT. They have not given us a date for when they will be paying on those invoices.. I have been covering payroll personally. We have 120 kids on this program and all of their services are currently under threat.”
What is your understanding of why this is?
“It is my understanding this new company that has taken over the billing is not entering codes correctly. They are not prepared for the amount of business we had. They weren’t prepared for the codes the providers were told to enter. The codes we’re entering are getting denied.”
How are you managing to deliver services with the non-payment?
“They gave me an interim payment when I said I was going to discontinue these cases. I will let them know when I need another check. I just don’t like having to threaten to discontinue services to 120 people in order to get paid for services we provided 70 days ago. We have the most outstanding so we have the most to lose. Smaller providers out there are getting interim checks of $5000, as opposed to what we’re getting. It’s a lot more money on the table for us because we’re a lot bigger. Now I’m asking, ‘When are you going to release funds for all of the services we have already provided?’ We are taking on new cases right now under this funding stream. We have authorizations that are starting up. I am wondering whether we are going to be paid in a year. I don’t know. If I thought we were never getting paid, I would terminate every single one of my cases that are under this funding stream and not take on any new ones. How long are we expected to provide services that we are not paid for? These families are in dire need of these services but I can’t ask my employees to work for free.’
Update: A very recent check with Travis Blevins shows he is still lacking tens of thousands of dollars in back payments for provided services.
State Payor Perspective
AdvocacyDenver reached out to the Colorado Department of Health Care Policy and Financing and requested an interview with Chris Underwood, HCPF’s Director of Health Information, who is responsible for claims processing and technology for the Department. Our request to interview Chris Underwood was denied. The Department’s Director of External Relations answered our questions.
Rachel A. Reiter
External Relations Director
Colorado Department of Health Care Policy and Financing
Why is the new system denying claims?
“We found the reasons for denying claims vary. Some of them are true system issues that we work through. Once we have a resolved issue, we work with providers to either rebill or just automatically reprocess those claims so they get paid once the system is in place. Others are errors somewhere in the enrollment or claim submission process. Other denials are appropriate based on policy, federal and state rules. The system is reflecting the new policy and perhaps providers are still learning that policy. It’s constantly evolving. There’s a big learning curve not only on the system’s side but also on the policy side.”
How are you responding to Medicaid providers’ reports of non-payment?
“While we know that more than $4.8 billion has been paid to providers, we know individual providers have struggled. We fully recognize that their claims questions need to be addressed. While it looks like a big number went out the door very similar to what we were paying last year in terms of total volume, we know some individual providers need some assistance in order to correctly bill their claims. That’s why we encourage providers to call us to let us know what their individual claims concerns are so we can work to identify unknown issues with the system and we can work together to improve those. We have tried to encourage providers to reach out to us directly so we can work on their specific questions and their specific claims. If there are broader systems that we can identify we can put in a large system fix. We have been doing that throughout the implementation and will continue to do that as issues become known. The Provider Services Call Center at: 1-844-235-2387 is our first line of assistance because our vendor has staffed that up significantly.”
What is the Department doing for providers experiencing financial hardship?
“We have interim payments available to them. Those interim payments are open to any fee for service provider that is enrolled with our system. You call that provider services phone number and then ‘Option Four’ to learn about those interim payments. We have been helping providers if they are getting used to the new system with those interim payments. Those will continue to be available as long as those providers need them. The interim payments are a percentage of the historic amount that has been collected. We are publishing a frequently asked questions document that goes over all those details related to the interim payments about the repayment schedule. (Download the Interim Payment Frequently Asked Questions here). We work with individual providers on those repayments. We also work with them on the length of time they might need those interim payments. We’re flexible dependent on the individual provider’s needs.”
Why are there late payments under Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit?
“There were a couple of known issues with EPSDT services that were identified that we have worked on throughout the summer. A couple of them were resolved but there are many that are ongoing. I would encourage any provider that is experiencing difficulty to reach out to us directly so we can work on their specific issues and look to see if it’s a broader trend across that provider type so we can work to address that for all those providers in that provider group. If you are looking for an online overview of issues and recently resolved issues, related to EPSDT or other services, you can go to our website at the Provider Resources Known Issues page which includes information by provider type.”
As a representative of Colorado’s Department of Health Care Policy and Financing, how do you respond to the hardships being endured by providers over delayed and non-payments?
“We are working with every provider that reaches out to us and taking it very seriously because they are critically important to continue to provide services to our Medicaid clients. We value our provider partners and are committed to continue to work with them through this transition. We know this has been a difficult transition not only for providers but for the state, as well as for our advocates and other stakeholders. We have seen a lot of progress over the last few months with some major issues getting resolved and payments getting out the door to those providers. We continue to look to forward progress and to make the system better for our providers.”
An Advocate’s Perspective
Advocate for Adults
From an advocate’s perspective, denial of claims and provider financial hardships can mean lack of services for their clients. As AdvocacyDenver’s Linda Brooks points out, providers can be irreplaceable individuals for a client’s well-being, independence, and safety.
As an advocate, what are you experiencing with your clients?
“In my work as an advocate, I am hearing directly from a host home provider and a service industry staff member they are not getting paid for the services they are providing. The concern I have is when a provider may not be getting paid, can they continue to provide those services? If they can’t, where does that leave my client? They have to be terminated from the services that are being provided in that residential setting and placed elsewhere, which certainly can be a problem. They (the providers) have grown to care for these individuals. They know them well. They know their support needs. Not getting paid, they can’t continue to provide services.”
Define the problems posed by delayed payments.
“The service agency staff member hadn’t been paid since January. No one gets rich in this field. To provide services simply because they want to, is all well and fine but there comes a time when you need money to provide services. You have to pay the mortgage, your household bills, if you have a car that you’re transporting that customer in, you have to pay for that. In the past, you never heard about people not getting paid. This is certainly something that’s new where people are saying, ‘I’m not getting paid as a provider.’”
Update: The host home provider referred to in this interview with Linda Brooks has since received four months of back payment for services.
October 17, 2017
The Colorado Department of Health Care Policy and Financing issued the following statement when asked how long they expect issues with the new claims payment system to continue:
“While most of the large system updates have been addressed, we know there are still individual providers and provider types who are needing help to resolve their claims issues. We are working with those individual providers daily to help – sometimes that will mean a system update, other times it is an issue unique to an individual provider or provider type.
Although we are able to be proactive with system updates, we are still in a space where we have to be reactive to any new issues brought to our attention by providers. It is important to note, the system will continue to evolve as new federal or state payment policies evolve.”