Over 300,000 Iowa Medicaid claims paid since April 1 privatization switch

DES MOINES - The three privately run managed care organizations now administering Iowa's Medicaid system have received, processed and paid more than 300,000 claims since taking over the state's duties April 1, the state's Medicaid director said Wednesday.

'It's good news right now for the first month of where we are,” Mikki Stier told members of the Iowa Council on Human Services.

'Billing is moving,” said Stier, who noted that Medicaid claim processing time is averaging about 10 days, which is below the 14 days allowed under the state contracts with Amerigroup Iowa, AmeriHealth Caritas Iowa and UnitedHealthcare of the River Valley.

Contacts with the state Department of Human Services' call centers set up to handle problems from Iowa's 580,000 Medicaid recipients during the managed care transition have dropped from 3,000 daily to about 1,500 each day, and up to 97 percent of Iowa's providers have signed up with at least one managed care organizations, while three of our four providers had registered with all three as of mid-April, Stier added.

'We've seen our call centers coming down, which tells us that we're getting there,” she said.

DHS Director Chuck Palmer said change is an upsetting and threatening thing to go through, especially when it involves health care, but fear is being allayed via a 'clear, sincere” effort to make the transition a success on the part of a lot of people pulling together.

'Most people, when you go into change, usually look for where they think the negative impacts could be,” Palmer said in an interview, 'so you usually assess what's coming at you by where are my vulnerabilities, where's my risk; most people don't rush to where's my opportunity?

'So, yes, there are those individuals who say, ‘oh, my gosh, here's what I'm afraid of.' As they've found that some of the things they were fearful of have not materialized, then the fear has gone down, and the comfort has gone up,” he added.

Cynthia MacDonald, plan president for Amerigroup Iowa, told council members Wednesday her company has received about 131,000 claims from Iowa Medicaid clients since April 1 and paid out about $15.5 million with an average response time of 4.6 days. About 6 percent of claims have been denied for reasons such as services not allowed or covered, coding issues or claims that exceeded the contracted rate, she said, but noted denials are subject to further review.

MacDonald said her company has hired 371 employees across Iowa to assist in delivering services to about 185,000 Medicaid members - including 7,500 in the Hawk-I children's health insurance program - and to work with more than 27,000 providers statewide that have contracted with Amerigroup.

'We're actually very pleased in how things have rolled forward,” MacDonald said. 'I think it's such a good thing for Iowans just to have it not be full of chaos and trauma. It's working very well.”