This business owner billed Colorado thousands in Medicaid payments and received only $288. She isn’t the only one. – The Denver Post
Ongoing problems with Colorado’s new Medicaid system to reimburse hospitals, doctors and caregivers for people with developmental disabilities are threatening small businesses across the state as they grapple with little to no income for nearly a month.
The issues are mostly related to operator error because service providers trying to bill the state for taking care of needy clients are unfamiliar with the new, more complex technology, according to the state Medicaid department.
“We’ve been communicating with providers about this for 18 months,” said department spokesman Marc Williams.
But service providers, especially small businesses, say the system is rejecting most or all of their claims for various coding errors and that when they call for help, they are waiting hours on hold to reach a person who then provides little help. Several said they are keeping multiple phone lines on hold simultaneously with the Hewlett Packard Enterprise call center.
Two cell phones at Jill Tullman’s speech therapy center were on hold or “talking to people with no help” for 2,584 minutes in the first two weeks of March, according to her calculations. Tullman employs five therapists in Colorado Springs and Centennial who help people who can’t speak communicate through tablets or eye-gaze technology.
Since March 1, the state has paid her just $288, despite that she bills from $8,000 to $12,000 per week for clients who have Medicaid government insurance. Tullman didn’t pay her last mortgage payment and borrowed money through her credit card so she could pay her staff.
“It’s beyond frightening,” she said. “This process has been a total cluster.”
State officials are “definitely not happy” with the call center, Williams said, noting the center run by Hewlett Packard Enterprise had a telephone software malfunction that caused calls to drop after an hour and 20 minutes and that the center was affected by damage to a fiber optic cable. Those issues are fixed and the current wait time is about one and a half hours, Williams said.
“It’s getting better every day,” he said. “We are in a much better place than we were 27 days ago.”
In its first month, the system has paid 48 percent of the nearly four million claims submitted. The rest were denied or put on hold for further information.
Williams said he isn’t trying to “throw providers under the bus” but that most of the problems are due to providers failing to learn the new system despite months of warning. All Medicaid providers were instructed to re-enroll or re-validate before the new system went live.
“We felt that we have turned over every rock in Colorado searching for providers who had not been enrolled,” Williams said, noting the state used a call center that tried to reach 7,000 providers that hadn’t completed the requirements.
Even large hospital systems have had trouble filing claims properly in the first few weeks, though most of those affected have been small mom-and-pop operations that already are swamped taking care of people with disabilities, he said.
Several providers said they thought they had completed the necessary steps to re-enroll only to discover they had not and all their claims were rejected.
Mountain Community Pathways in Evergreen, which runs a day program for adults with developmental disabilities as well as a home for three disabled adults, is waiting for $60,000. “We will have to close our doors for services if we cannot get paid soon, which does not do justice to all of our clients,” said owner Cindy Reynolds.
She and her business partner had to borrow money from a bank to help cover expenses. Reynolds said she has yet to get help from the call center, despite several hours on hold.
State officials said the call center recently hired additional staff and that HPE has worked overnight for weeks to fix system “hiccups.”