The goal of KanCare is to improve outcomes for beneficiaries and taxpayers through integrated, whole-person care. Our providers have done an outstanding job doing what is best for members, helping patients get back into their homes sooner and providing services that consumers might not have received otherwise. That is not to say we aren’t aware of and concerned about the administrative issues some providers are experiencing 10 months into KanCare (“KanCare system criticized in Topeka hearing,” Oct. 8 Eagle).
Concerning recent news articles on the topic of payments to KanCare providers and the authorization of services, I want to make sure the indicators are available for readers following this issue. Through September, total claims payments from the health plans to providers were running 98 percent of where they were during the same period in 2012 under the old Medicaid system. For medical services, which include hospitals, total claims payments are at about 95 percent of the 2012 total.
KanCare health plans are now processing a collective 97.9 percent of clean claims within the 20-day pay-for-performance standard. A “clean claim” is one that can be processed without obtaining additional information from the provider or from a third party. But we know the KanCare health plans can do better.
That is why the health plans are strictly held to operational standards they must meet to receive payment from the state. Performance in these measures – timely claims processing, grievance resolutions, customer service, etc. – is tied to 3 percent of the payments the state makes to each health plan.
The KanCare team is working with doctors, health plans and consumers to ensure that needy Kansans receive the health care they need when and where they need it. That’s what is happening with KanCare today, and we expect it to improve in the future.
Director of communications
Kansas Department of Health and Environment