SOURCE: Washington State Department of Social & Health Services

December 06, 2010 22:04 ET

Statement in Response to Seattle Times Article on Medicaid's ProviderOne Payment System

OLYMPIA, WA--(Marketwire - December 6, 2010) - The following statement is from Deputy State Medicaid Director Heidi Robbins Brown following the Seattle Times publication of an article about ProviderOne on Sunday, December 5:

On May 9, 2010, the State of Washington launched ProviderOne -- its new computerized payment system for the Medicaid program. Our federal partners and Medicaid programs in other states have verified that it was one of the smoothest launches by any state in recent times. From that week on, ProviderOne has made every payment cycle, paying bills more accurately and faster than the 25-year-old legacy mainframe it replaced. ProviderOne was built so that it can be updated in modules, saving money on future changes, and it will offer a wealth of decision-support data, helping the state evaluate its health-care programs and costs more effectively.

Sadly, the Seattle Times chose to focus on a few critics and misinformation about "computer glitches" instead. The article described the system as over budget and poorly planned. It suggested the system was unable to keep up with provider billings, currently facing a revolt of Medicaid providers threatening to stop taking new Medicaid patients, and recreating a disaster that occurred when the state of Maine tried to launch its new Medicaid payment system without adequate preparation.

These allegations are simply not true. Although the reporter had two lengthy interviews with Medicaid staff and other conversations with staff, the article does not reflect the facts.

Fact: The system is not "over budget." The ProviderOne budget was controlled by the State's Information Services Board and the federal Medicaid program, and the project stayed within that funding. Additional budgeted costs were approved for two reasons: 1) To thoroughly test the system to make sure it would pay accurately, and 2) to provide additional provider training and testing opportunities. Payments under the contract were also based on acceptable deliverables, which meant the contractor was never paid until the work was done to the project's satisfaction. The project took three years longer than we first anticipated, but the delay did not cost taxpayers a dime.

Fact: The system was well planned and represents the state of the art in Medicaid billings and payment systems. ProviderOne met its first payment deadlines the first week of operation and has not missed a payment cycle since implementation. The level of payments statewide is clearly on target to reach the program's $4.4 billion total payments expected for fiscal year 2011.

Fact: Claims suspend for a reason, not because of "computer glitches," as the story suggests. Either the claim has errors or it needs human review and intervention, especially for complicated claims that may include diagnosis codes, additional medical charts and other information. These safeguards protect taxpayers and enforce payment integrity by making sure the system is paying the right amount for the right reason. ProviderOne catches overpayments before we cut the check, saving us the problem of tracking them down later and demanding reimbursements. Ninety-seven percent of Medicaid claims are being processed by ProviderOne. Of the three percent suspended, half are paper claims, and most of those are duplicates.

Fact: Washington State's ProviderOne has little in common with the Maine payment system's implementation. Maine's new system launch experience came seven years ago. The same contractor also worked on Michigan's new payment system, which launched last year without significant problems. The bad experience in Maine reflected a lack of staff and provider preparedness. There is no parallel with ProviderOne.

Fact: Some providers are having difficulty with ProviderOne. The system implements new federal standards on payment integrity as well as national medical transaction standards, including computerized taxonomy, provider identifiers and HIPAA codes. But most providers -- especially those who took the opportunity to test their practice software and billing systems in ProviderOne -- have successfully made the transition. ProviderOne's payment record tells this story.

In an era of tight resources, we are still doing our best to work with providers who need help, and we have had great success with those who attend our webinars, educate themselves with our billing manual, or follow the self-help guidelines posted on our Internet pages. We share their frustration that our call center staff is a third smaller than it was two years ago, making it often difficult to reach us by phone. We also acknowledge the steep learning curve these providers face. But it is a mischaracterization to imply, as the Times did Sunday, that these complaints represent a large or growing number of providers and billers. 

DSHS does not discriminate and provides equal access to its programs and services for all persons without regard to race, color, gender, religion, creed, marital status, national origin, sexual orientation, age, veteran's status or the presence of any physical, sensory or mental disability.

Contact Information

    Heidi Robbins Brown
    Deputy State Medicaid Director

    Jim Stevenson
    Communications Director

    Jim Stevenson
    Pager: 360-971-4067