Four months after the snafu appeared, the state’s Medicaid payments system remains fouled. For some providers, weary of waiting to be paid by the state for the health-care services they’ve delivered, patience is wearing thin.

Ditto for some legislators.

“It’s very frustrating,” said Sen. Peggy Rotundo, a Lewiston Democrat who co-chairs the Appropriations Committee.

Her committee is getting weekly updates from the Department of Human Services and a host of other state agencies that have been called in to fix the multimillion-dollar problem.

Progress, said Rotundo, is glacial.

“There are still significant problems,” she noted. And that’s “despite the best efforts of the governor,” Rotundo said.

In early March, Gov. John Baldacci said he had given DHS Commissioner John Nicholas “30 days to fix the problem,” adding, “This has to be done. I’m taking action. People will be held accountable.”

On Tuesday, Lynn Kippax, Baldacci’s spokesman, said his boss “has paid a remarkable amount of attention to this issue,” including assigning highly placed members of the administration to rectify it.

The administration at that time brought together a bevy of experts under the watch of Administration and Finance Commissioner Becky Wyke to create a task force to tackle myriad computer glitches.

Among them: Dealing with more than 300,000 suspended claims already in the system – claims that are in limbo and have yet to be decided – and paying approved claims at a rate higher than 50 percent.

“There has been a lot of progress,” said Pat Damon, one of the task force members. But, he added, “There will be no quick fix. We want to solve it correctly.”

Damon, assistant commissioner of the Department of Administration and Finance, has been charged with seeing that service providers get paid. Those providers range from nursing homes and doctors to mental health counselors and agencies.

Damon said many of them have been financially frustrated for months. He praised their patience. Now, he said, at least those people “are getting a piece of the pie.”

The MaineCare problems began in mid-January. That’s when the state changed its Medicaid billing and computer programs system from one that had been in use for about 20 years to one created by CNSI, a Maryland-based firm.

The new programs, called the Maine Claims Management System, were plagued from the onset.

Service providers attempting to file claims electronically found their efforts would “crash the system,” said Damon.

Soon officials learned that was just one of many problems.

Another: Claims that made it into the system languished in a sort of computer netherworld, being neither approved nor denied.

That particular problem is being resolved, Damon said Tuesday. Soon, bill payment documents will include some approvals as well as some denials, as should be the case, he said.

And in nearly every instance, the 7,000 people, agencies and institutions that provide Medicaid health services in Maine are seeing some payments arriving in the mail.

In some cases, the checks aren’t only partial payments, either.

Linda Hertell, president and CEO of Richardson Hollow, a Lewiston mental health agency, said that after initial delays, she’s now receiving money regularly from the state.

“We have been getting lump sums,” she said.

The problem with that is that the payments aren’t linked to any particular bills, but appear to be based on past billing history.

“It’s going to be costly to try to match up payments with bills,” she noted, but it’s still better than going without payments.

Hertell said she’s heard from other providers who haven’t been receiving payments, or who are receiving much smaller payments.

Rotundo said providers who aren’t getting payments or who experience other problems should contact their legislators.

“We can help,” she said, “if we’re made aware of the problems.”

Some of those providers attempting to bring problems to the state’s attention were frustrated by a telephone system linked to the faulty computer system, she noted. Damon said that glitch is among several that have been fixed or are near resolution.

Neither official would predict a speedy resolution to other problems.

Damon said the task force is still in the process of identifying the computer program’s shortcomings. As they’re found, the problems are being worked on and some are being fixed.

Rotundo said task force members and others are “working day and night” to get the system to function properly. Representatives of CNSI are working with state technology experts to make fixes.

Still, she said, “It is taking a long time in spite of all of that. We don’t have a definitive date” when the Maine Claims Management System will be working as promised.


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