Florida Medicaid Computer Still Ailing

Jan 16, 2009

Tampa Tribune--January 16, 2009


Problems erupted with the state’s new Medicaid payment system the day it went online seven months ago, and they haven’t gone away.

The Hillsborough Achievement and Resource Center has lost about $12,000 in the past month because of a computer glitch that prevents it from billing for services at their full rate. The center provides day training and residential services for people with mental retardation, autism and other developmental disabilities.

HARC isn’t the entity having problems. Since July, the state Agency for Health Care Administration has provided nearly $500 million in emergency reimbursements to nursing homes, home health agencies and other providers that could not get their claims through the new computer system.

The state hired Electronic Data Systems of Plano, Texas, more than three years ago, agreeing to pay it more than $300 million to develop and maintain the system for the state’s $15 billion Medicaid program.

The billing problems peaked in the weeks after the system began operating, in June, said Agency for Health Care Administration spokesman Fernando Senra. Even now, the state is sending out up to a dozen emergency payments a week, he said.

HARC’s early problems have been resolved, but a new one cropped up about a month ago, said assistant controller Shirley Burdett.

When she tries to bill for a service that costs $1.48 a quarter hour, for instance, she gets an error code until she revises the form to request the next lower cost, $1.16.

Some claims go through at the correct rate. Some don’t.

She double-checked her payment data to make sure she was using the correct rates. She e-mailed the state and Electronic Data Systems. She also called the system’s help line, suggesting after the 10th or 11th call that it change its name, “because they are no help at all.”

Still, the problem continued.

Last week, EDS representative Amber Ward told Burdette by e-mail that other providers were having the same problem. Ward said it was “in the research phase at this time and people in Tallahassee are determining the issue. It is now on our known issues list.”

Problems with the new system began the day it went into operation. Providers described a variety of complications. When submitting a claim, for instance, many were told they didn’t have billing authorization or their client was not eligible.

The health care administration said the system was working well for most providers. For the dozens having problems, it provided emergency payments until the problems could be solved.

The problems are part of breaking in a system, and EDS is dealing with them as they are reported, Senra said.