Medicaid contractor receives grateful reviews

Rebekah Scott, a mental health counselor in Nampa, Idaho, was late on rent for three months.

That’s because she didn’t receive any money for the Idaho Medicaid patients she treated, who make up the majority of her patients, she told the Idaho Capital Sun in an interview.

As a divorced, single mother with disabled children, she said she was “already kind of on the rocks.” But when her salary dried up, she continued to see patients, even as she struggled to keep the electricity flowing.

In October, she said she finally received her first payment of $149. That came after she said Magellan of Idaho, the new Idaho Medicaid contractor that manages mental health benefits, worked with her to fix billing problems that she said resulted from the use of outdated billing code information.

But more checks have come in since then, she said. And more are on the way.

Even as Idaho’s Medicaid mental health providers have experienced payment delays since Magellan took over the $1.2 billion contract in July, they and other providers say they appreciate Magellan’s quick and responsive work in resolving billing issues are grateful.

“A lot of what we’re seeing is just weird, random things that just aren’t worth it right now,” said Laura Scuri, co-chair of the behavioral health subgroup in the Idaho Association of Community Providers and co-owner of Access Behavioral Health Services in Boise . “But my business partner, who has been doing billing for almost 20 years, said this is common. Every insurance company has unintended consequences every time they make a change and things don’t get processed.”

What’s new, she said, is Magellan’s strong communication.

“I can text and get a response,” Scuri said in an interview with the Sun. “What – that’s never happened in my life.”

Some providers also say they expected difficult periods in the new contract, as Magellan will now be tasked with managing more aspects of mental health services, compared to previous contractor Optum, which also initially delayed payments to providers.

Juliet Charron, deputy director of Idaho Medicaid and Behavioral Health at the Idaho Department of Health and Human Services, said the transition to the new contract was smooth.

“I won’t discount the fact that there have been bumps in the road. And we expected some surprises,” she told The Sun in an interview. But she says health officials have focused on whether patients are continuing to receive services and whether Magellan is working quickly with providers on payment issues.

“Overall, we have … seen that Magellan is a very good partner for providers,” Charron said.

Idaho-based Magellan did not respond to the Idaho Capital Sun’s requests for comment for this story.

What caused late payments? A new, expanded contract, some say.

Even before Magellan took over the contract, Idaho Medicaid mental health providers predicted payment delays, in part because Magellan had not tested the systems as quickly as some providers had hoped, the Sun previously reported.

While some providers have coped well with the new change, David Lehman, lobbyist for the Idaho Association of Community Providers, said some are still trying to figure out how to get paid. A number of providers’ concerns about the introduction of the new contract were “well-founded”, he said.

“We were concerned early on that Magellan needed to provide more training and instruction to providers on how to use the billing systems,” Lehman said.

For crisis center services, Rehabilitative Health Services has received quick payments from Magellan — even though this is a new benefit in the contract, CEO and President DeVere Hunt told the Sun in an interview. But for another program new to the contract, a preventative mental health program called Early Serious Mental Illness (EMSI), Hunt said Magellan is four months behind on payments to his clinic.

Magellan leadership has been “extremely responsive” to try to resolve payment issues with that program, he said. Hunt attributes the late payments to growing pains.

“I don’t think there was an intentional delay in payment. It was just a process to understand how modifiers are billed differently than at Optum or how they might be billed at other companies,” he told the Sun.

He said that in his opinion, “these are just transitional elements as we try to develop these new processes within the billing systems.”

Magellan’s billing software is “pretty clunky,” Scuri said. She said a handful of providers have decided to stop offering behavioral health care since changing contractors, and some very small providers have told her they have closed.

Issues with medical payments are the norm, she said. And Magellan’s contract has “three times as many working, moving parts” as Optum’s, she said.

“So there will be issues, but they are responsive, which we didn’t experience back then (under Optum). So there are still problems and they are big because they affect so many people, but they are not unusual for an insurance company,” Scuri said.