Under the Dome

Dome: Billing processor raises concerns about NC’s new Medicaid payment system

From Staff ReportsJune 19, 2013 

An insurance claims clearinghouse that works with North Carolina healthcare providers is worried about the state’s new Medicaid payment system.

An executive with Florida-based Availity wrote a letter to state Department of Health and Human Services Secretary Aldona Wos saying the company has not been given “numerous operational details” about the system.

Providers file insurance claims with Availity, which then submits them for processing. The letter’s author, Availity Senior Vice President of Provider Solutions Scott Herbst, declined through a company spokeswoman to be interviewed.

The state Department of Health and Human Services will switch to the new system July 1.

DHHS spokesman Ricky Diaz said Computer Sciences Corp., the company that built and will operate the system, has set up a special technical support group for companies such as Availity. The agency and CSC are readying a “war room” for July 1, where problems with payments can be handled quickly, Diaz said.

“We’ve been pretty up front with the fact that we expect some bumps in the road” based on other states’ experiences with switching to a new bill processing system, he said.

The department announced earlier this month that it had completed final tests of the system, and that more than 1.2 million claims were paid successfully.

Forest: Protect ‘the rule of law’

Lt. Gov. Dan Forest says a North Carolina bill to allow immigrants in the country illegally would lead to “an influx of illegal aliens” and drain the state’s social welfare programs.

“Those of us elected to office owe it to the citizens of our state to protect the rule of law,” the Republican wrote in a letter to the editor published in the Winston-Salem Journal. “Our legislature should pass laws that encourage legal actions, not illegal ones.”

Forest’s stance makes him the most prominent opposition to date on the immigration bill, dubbed the RECLAIM NC Act, which would also allow immigrants to be jailed while police check their immigration status. The bill’s sponsor, Rep. Harry Warren, considers it a compromise measure to make roads safer and free police to focus on criminals. The legislation is stuck in the House Finance Committee, where it has sat since early May.

“In a civil society, it is necessary to not reward illegal behavior otherwise more illegal behavior will follow,” Forest wrote.“… Rewarding illegal aliens with a privilege that is reserved for citizens and those lawfully present in North Carolina is wrong.”

Hygienists lobby senators

Dental hygienists who work for the state took the day off Wednesday to tell senators how important their jobs are to keeping children’s teeth in good shape.

The Senate budget proposal cuts the Oral Health section in the state Department of Health and Human Services, which includes 39 hygienists who work to prevent cavities in school-age and pre-school age kids.

Sixteen of the 39 were knocking on senators’ doors Wednesday.

The state traveling hygienists put sealants on eligible children’s teeth at school and refer them to dentists for fillings, said Wendy Schwade, a hygienist from Durham who works in Granville, Vance and Person counties. The state hygienists work in 80 counties, according to information from the office.

The Senate budget cuts all the jobs and $2.8 million, and sends $1.6 million to local health departments that sponsor dental clinics. But 51 counties don’t have dental programs that would be eligible to take the diverted funds, according to the Oral Health office.

The House budget proposal spares the office.

Staff writers Lynn Bonner and John Frank

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