Some Nebraska providers dissatisfied with changes to Medicaid managed care system

Nebraska's new Medicaid managed care system is receiving less than stellar reviews from some behavioral health and home health providers who cite various problems with the system, including unpaid claims, reports the Omaha World-Herald.

Here are four things to know.

1. The state contracts with UnitedHealthcare Community Plan, Nebraska Total Care (Centene) and WellCare of Nebraska through Heritage Health, the state's Medicaid managed care system, to administer physical health, behavioral health and pharmacy Medicaid services to approximately 230,000 state residents, according to the report.

2. Behavioral health and home health providers have expressed dissatisfaction with the system, which launched nearly five months ago, according to the report. Among their concerns are unpaid claims and failure to receive authorization for patient care.

3. One agency saw unpaid Medicaid claims of more than $300,000, and providers are also concerned they eventually may not be able to continue providing care to Medicaid beneficiaries, reports the Omaha World-Herald.

4. However, Calder Lynch, director of the division of Medicaid and long-term care at the Nebraska Department of Health and Human Services, defended the program. He told the Omaha World-Herald his staff, as well as the staff at the three managed care plans, are making improved efforts. For instance, one managed care company lagged in paying claims due to computer problems, but the company added and shifted staff to address the issue, he noted.

"I understand the urgency that providers feel when it comes to things like cash flow and ability to serve their clients, and we're keeping the pressure on ourselves and on the plans" to rapidly address problems, he said.

Read the full story here.


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