TOPEKA – None of the state’s KanCare providers met benchmarks for timeliness in claims processing during 2013, according to a survey by the Kansas Department of Health and Environment.
The state set a goal to have all “clean” claims, or those that don’t include processing problems, completed in 20 days, while all claims need to be processed within 60 days, the Wichita Eagle reported.
Medicaid is known as KanCare in Kansas, and its management was turned over to the three private health insurance companies by Gov. Sam Brownback.
Those providers – Amerigroup, Sunflower Health and United Healthcare – failed to meet that benchmark in any month last year, according to a report from the KDHE released this month.
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“We withheld a portion of their payments for the year,” KDHE spokeswoman Sara Belfry said, referring to Medicaid reimbursements from the state.
The state and the providers have monthly meetings to discuss the problems and other issues, Belfry said.
“Claims processing has certainly been something that we know has been an issue,” she said. “We continue working through this with them.”
The companies did meet a goal of resolving 98 percent of all inquiries within two business days from receiving them in each month of 2013.
More than 8 million total claims were made from January through June of this year, with about 15 percent denied, according to the report. From April through June, 70 of 217 appeals were granted in the patient’s favor.
There were also more than 500 grievances filed against the three companies during the same three months, with billing and financial issues and timeliness among the top complaints, the report said.