March 11, 2005
Commissioner Updates MaineCare System Status
MaineCare increased the amount of claims paid through its new claims management system and took several steps this week to continue improving the system’s performance.
The weekly status report shows that MaineCare paid $26 million in claims during the week ending today.
“There was important work done this week and our emphasis is to build on that and get our system performance and reliability back to where operations are normal and routine for MaineCare providers,” said John R. Nicholas, Commissioner of the Department of Health and Human Services.
MaineCare put in place a new claims management system January 19 to meet federal standards for its health insurance program and to upgrade a system that was more than two decades old. In the early weeks of the implementation, about 30 percent of claims were paying normally. Interim payments were needed and continue to be needed to make up the difference for providers relying on MaineCare that had not received payments.
“We appreciate the frustrations this has caused to providers and we’re focusing our actions on getting to what providers need most, which is a return to routine claims process,” Nicholas said.
Among the recent actions:
· The Department hired an outside vendor for project management support. · Contracted with outside vendor to add staff to assist with answering provider inquiry calls. · Instituted regular weekly mailings to inform providers of system progress.
In addition to the $26 million paid through the new system last week, MaineCare paid $4.2 million in interim payments to providers in the week ending March 11. Prior to the implementation, the old system had processed about $31 million in claims during a typical week.
Interim payments, in addition to those payments processing routinely through the new system, have been needed because of the low volume processing in the early weeks of implementing the new system. A focus of status updates in the coming weeks will be reconciling interim payments with a higher volume of claims that begin processing in the new system.
MaineCare is a health insurance program funded jointly by the federal government and the state. It has 7,000 billing providers and serves about 262,000 Maine people.