Report: KanCare providers fail on timeliness in processing claims last year

08/12/2014 12:18 PM

08/13/2014 12:34 PM

None of the state’s KanCare providers hit the state’s benchmark for timeliness in claims processing during any month in 2013, according to an August report from the Kansas Department of Health of Environment.

The state set a goal to have 100 percent of clean claims processed in 20 days and 100 percent of all claims processed in 60 days. The state’s three KanCare providers — Amerigroup, Sunflower Health and United Healthcare — failed to meet that benchmark for all 12 months of 2013, according to the KanCare executive summary released this month.

“We withheld a portion of their payments for the year,” said Sara Belfry, spokeswoman for the Department of Health and Environment. “But we continue to work with” the KanCare providers.

“We have monthly meetings with them to discuss this issue. Claims processing has certainly been something that we know has been an issue. We continue working through this with them.”

The companies were able to meet a customer service goal to resolve 98 percent of all inquiries within two business days from the receipt date in each month of 2013.

The report also tracks the progress of KanCare through the first part of 2014. From January through June, there were more than 8 million total claims made and about 15 percent were denied.

From April through June, there were 217 appeals made, with 70 being granted in the patient’s favor.

There were also more than 500 grievances filed against the three companies during the same three-month time span. “Billing and Financial issues” was among the top reasons listed for grievances and appeals for each company, as was “Timeliness.”

Belfry said KDHE was tracking that data to inform its discussion with providers on how to improve effectiveness.

“If we see a pattern of grievances obviously we would address that,” she said.

Reach Bryan Lowry at 785-296-3006 or blowry@wichitaeagle.com. Follow him on Twitter: @BryanLowry3.

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