For this big time transformation,
we're four weeks in a day now.
Is that right? Correct?
Just about a month from your perspective,
how has it gone so far?
Well, so far we haven't had the any
any large issues that we haven't
been able to work and has managed
care transition and you know it's
a it's a significant transition.
Moving 1.6 million people from a
fee for service system to a managed
care system where there are five of
those managed care entities providing
oversight for our system now,
but not issues that that that there
are issues that we've been working
at concern us but but nothing that
hasn't been overwhelming our system.
How many denials are we
seeing roughly? And and why?
So it so it's it's multiple reasons in
taxonomy really is just part of the
billing process where you have to say
what kind of provider you are essentially
is in that taxonomy code and and we
don't have all of the exact reasons,
but we believe several things happen.
One is that when when people move from
our fee for service system they were
submitting directly to our system of record,
NC tracks one way when they moved
to these five health plans they may
have changed something in the list.
So it might have picked it off.
Or seeing it differently,
I often equated to as when I go
on a Amazon and order something,
I have all my information in there.
But if I try to use the same
information with another site,
it might kick me off because it
feels like a little bit differently.
So some of that and then and then there
are some things where people maybe not
have updated their taxonomy information
over the course of the past four years,
and when they shifted a new system,
it might have been kicked out,
but it's those kinds of really technical
technical issues that really have been.
Sort of,
the heart of that issue,
as people are feeling and I know
that in talking to several now we've
talked to at least a handful of
different specific speech therapists.
They say that they they're
they're experiencing in some ways,
five different ways of doing business
with these five different companies.
It hasn't been an issue streamlining this.
It's it's a. It's a great question.
We've tried to do as many things as
we can to streamline this transition,
but the one thing we can't change is that
there are five plans now where people
build rather than one which was us.
And although most most of the
plans are trying to do things to
be as consistent with each other,
but each one of them brings a
different platform because they are,
you know, national organizations
who do this work across the country,
so you are seeing that,
and I think I think like any
in any insurance.
It will take a while for people to
get really comfortable with that,
but we believe that one is that
the plans are working closely with
them and then two that as folks
have more experience with it.
These things will
smooth out. You mentioned the really
technical kind of issues that seem like
clerical that are leading to denials,
and it sounds like you're
suggesting from the providers and
just some information may not
be into the system correctly.
How many of those?
How wide ranging are we talking about?
You know
it that that's it's hard for us to tell.
What we do is that. People will,
we don't know one is that that how many
times we don't hear about it, right?
So that's one thing.
So we we we have asked people to work with
their health plans directly to do that,
so that but we get a significant amount of
tickets that come in and tell us that stuff.
I don't have the exact number on it,
but they're significant, right?
We get this information.
Our team works those pretty rapidly
with those health plans to try to
address those with what I would say
is that the number that we received
actually is less than we would have
anticipated with this transition,
but they are very specific.
Providers at that or having more difficulty,
and I think some of the
what I would describe.
Some of the smaller specialized
therapy providers in particular
seem to be having more difficulty,
and that might be because the
health plans haven't worked with
them as much in other places,
and and again,
it's a big transition for them in this move,
and we're talking about really
small businesses like,
you know it's we
are super tiny that you know we're
not used to having to hire A billing
person to handle their billing, right?
That's correct, you have that happening.
And then there's probably
another issue that that.
Gets conflated here.
Is that there are some of these providers,
actually something we was that
even in total or program.
I think we you you asked about.
At one point they were they
provide contract services for the
state agency that does that work.
Originally, they were intended to be
inside of managed care at the last minute,
and appropriately the General
Assembly remove them from that.
So they've carved out.
But we had program in our system so
that they would be in managed care.
And frankly, from the state standpoint.
It's taken us way too long to
reprogram this program to system,
but we believe by August 16th
that'll be correct and we've sold it,
said those providers,
that if they are having cash flow issues,
we can provide what we call
as a hardship payment.
Basically an advance on those buildings.
And today we've had about, not about.
We've had 17 of those requests
come in that we've honored,
so we're trying to make sure that
none of those small businesses or
or put in a position to where it
it causes a problem with them.
With payroll or any other bills
that they have.
So
you really have two layers.
You have this big time transformation.
Then you have this last minute
change that the state hasn't
really pivoted quickly enough on.
That's correct in talking to several
different kind of speech therapists,
you know they're they're having issues.
Number one with reimbursement.
For whatever reason,
they are not getting paid.
It's been a month they
have not received payments.
How is that acceptable?
It's not, I'll say to you is that you
know when we when we let me let me sort
of talk about our priorities right?
Our number one priority is that that
was that people will continue to get
seen as this transition happen and
those providers are doing exactly that.
The second thing we committed to is making
sure those providers would be paid.
And so why I mentioned the hardship payment.
Is that what we committed is that
either the health plans themselves,
but they weren't getting paid.
We do these hardships,
or if they weren't, we're the backstop.
And Medicaid will make those payments
available. So again, 17 is a.
Is a relatively small number,
but we think it's the number of
folks that actually today need
those payments to make sure they're
hitting payrolls so not acceptable.
We're fixing it,
but we also have the the backstop
if you will of that.
Are charging payment that's
available for those providers now.
Is that hardship
payment available for anyone in Medicaid?
Right now? The managed care. Yeah, so how
how we we're pushing it out?
Is that if there is a provider and
they are building a health plan?
We've told our health plans.
We expect them to do the same thing.
If they can't get a payment.
Out for blood or seven at difficulty,
they'll have those hardship payments
inside of managed care if it's
a Medicaid direct issue for us,
we'll do it as a Medicaid program,
but frankly, if we can't,
if we have providers into place
to where they can't get paid help
plants can't do it quick enough.
We're prepared to be that backstop as well.
That's good to know,
and I'm going to certainly
tell the people that have reached
out to us immediately today.
That that's an option for
them if they need it.
I know some of the smaller ones
are really kind of concerned,
which leads me to my next question.
In talking to some of these businesses,
they have a real fear of having
to put some kids on hold of
seeing their services if they
are not going to get reimbursed.
What should these businesses
tell their patients?
Well, I think I think
the most important thing for them
to do is to let us know if they're
at that place to where they believe
that they can't take patients
'cause they're not getting paid.
We want to know because we that's that's
not something that's acceptable to us,
certainly not acceptable to the folks that
worked on this managed care transformation,
and I know it's not.
Acceptable health plans either.
So let us know.
Make sure that we're aware of it
so we can address those issues
and they know how to get in contact with
you. All these providers we've had the
information out there a lot, and again,
if they can't, you can give him my
email. So cool and kind of just in closing.
Obviously this has been years
in the work in the works right,
and I think that like from a
very general broad perspective,
I think everyone sees it
a little bit differently.
Don't know, kind of health care
association isn't ready to call it
a significant concerns yet, right?
There are certainly some parts
of this transformation.
Have not gone great by your own admission,
right? But overall,
it sounds to me like you feel like this
is better than you thought it would be.
I can tell you based on the
people that I've talked to,
this is worse than they feared.
And when you've had years
to prepare for this,
how do you explain that to them?
I think it's a great question and I would
say you know prior to coming to state
government I was a renter organization
provided services and if I was the organ,
if I was the organization
that wasn't getting paid,
I would feel exactly as they did.
So I wanna be clear is that there is no
nothing of this is acceptable to them.
But when you think about a transition
this big right when you have 1.6 million
people you know large amount of money
changing in terms of shifting aside 5A
new health plans in in the in the mix.
The the transition has gone relatively
smooth and I say that is relatively is
really important to describe that we've
got issues around other places where
we're worried about beneficiary impact
and and we don't want that to happen.
But again, 1.6 million people,
the vast majority of those transitions
have gone well for those individuals,
and what we're trying to do is
make sure that we work on these,
that you're raising another raise.
Get them addressed and fixed.
There will always be a problem, right?
But make sure we get that as
smooth as possible.
So that we can see the benefits of
this transition in the coming months.