Despite delayed payments from new Idaho Medicaid contractor, providers grateful for responsiveness

Rebekah Scott, a mental health counselor in Nampa, was late for rent for three months.

That’s because she wasn’t getting paid for the Idaho Medicaid patients she treated, who make up the bulk of her patients, she told the Idaho Capital Sun in an interview.

As a divorced, single mom with kids who are disabled, she said she was “already kind of running on fumes.” But when her pay got delayed, she kept treating patients even while she struggled to keep the power on.

In October, she said she finally got her first payment of $149. That’s after she said Idaho Medicaid’s new contractor running mental health benefits, Magellan of Idaho, worked with her to fix billing issues that she says stemmed from using outdated billing code information.

But since then, she said more checks have come in. And more are on the way.

Even as Idaho Medicaid mental health providers have seen delayed payments since Magellan took over the $1.2 billion contract in July, she and other providers say they’re grateful for Magellan’s quick, responsive work to fix billing issues.

“A lot of what we’re seeing are just weird, random things that just don’t pay right now,” said Laura Scuri, co-chair of the behavioral health subgroup in the Idaho Association of Community Providers and co-owner of Access Behavioral Health Services in Boise. “But my business partner, who has done billing for almost 20 years, said that’s common. Every insurance company – every time they make a change, they have unintended consequences, and things don’t process.”

But what’s new is Magellan’s strong communication, she said.

“I can shoot a text and get a response,” Scuri told the Sun in an interview. “Which – that’s never happened in my life.”

Some providers also say they expected rough patches in the new contract, since it’s now tasking Magellan with managing more aspects of mental health benefits, compared to the previous contractor, Optum, which also initially delayed payments to providers.

Idaho Medicaid and Behavioral Health Deputy Director Juliet Charron, at the Idaho Department of Health and Welfare, said the new contract transition has been smooth.

“I will not discount the fact that there have been bumps. And we expected some bumps,” she told the Sun in an interview. But she says health officials have focused on whether patients are still getting services, and if Magellan is quickly working with providers on payment issues.

“By and large, we have … seen Magellan to be a very good partner with providers,” Charron said.

Magellan of Idaho did not respond to the Idaho Capital Sun’s requests for comment for this story.

What caused payment delays? A new, expanded contract, some say

Even before Magellan took over the contract, Idaho Medicaid mental health care providers predicted payment delays, in part because Magellan hadn’t tested systems as soon as some providers hoped, the Sun previously reported.

While some providers have fared well under the new transition, Idaho Association of Community Providers lobbyist David Lehman said some are still trying to figure out how to get paid. A host of provider concerns before the new contract rollout were “well founded,” he said.

“It was our concerns early on that there needed to be more training and more direction from Magellan to providers on how to use the billing systems,” Lehman said.

For crisis center services, Rehabilitative Health Services has received quick payments from Magellan – despite that being a new benefit in the contract, CEO and President DeVere Hunt told the Sun in an interview. But for another program that’s new to the contract, a preventive mental health program called Early Serious Mental Illness, or EMSI, Hunt said Magellan is four months behind on payments to his clinic.

Magellan leadership has been “extremely responsive” to try to resolve the payment issues with that program, he said. Hunt attributes the delayed payments to growing pains.

“I don’t think there’s been a delay of payment intentionally. It’s just been a process in understanding how modifiers are billed differently than how they were with Optum, or how they might be billed with other entities,” he told the Sun.

He said he thinks “it’s just the transitional pieces as we’re trying to develop these new processes inside of billing systems.”

Magellan’s billing software is “pretty clunky,” Scuri said. She said a handful of providers decided not to offer behavioral health since the contractor shift, and that a couple of very small providers told her they closed.

Issues with medical payments are the norm, she said. And Magellan’s contract has “three times the working, moving parts” than Optum’s, she said.

“So there’s gonna be issues, but they’re responsive to them, which wasn’t our experience back (under Optum). And so there’s still issues and they’re big, because it impacts so many people, but they’re not unusual for an insurance company,” Scuri said.

How Nampa counselor scraped by as her pay stalled

Even in the three months she was late for rent while her payments from Magellan stalled, Scott says she kept seeing Medicaid patients.

She scraped together enough to pay rent, using money from another job and money her disabled son chipped in from his job, she said.

But she said she lost her car. Her power has been shut off often enough that she said her kids are used to it.

Scott enrolled in Medicaid and SNAP, commonly called food stamps, she said.

Her taxes and student loan payments are deferred, she said.

She signed a new lease, for a shorter nine-month period and for an extra $200 monthly rent, she told the Sun.

Magellan has helped providers quickly

Lehman, lobbyist for a provider group, told the Sun that the contract’s rollout has been “much more successful” than under Optum, which first took over the contract a decade ago.

Large providers – with professional billing staff – have fared better under the new contract transition, particularly for getting paid, he said.

“For smaller providers, who don’t have the same level of resources, I think they’ve struggled more,” Lehman said.

But Lehman stressed that Magellan has worked hard to respond to providers’ concerns. He said Magellan of Idaho’s CEO David Welsh has personally taken several customer service calls.

“There is still hope that things will continue to improve, and I believe that Magellan is making an effort to try and meet the concerns that providers have. But certainly, it has not been the same experience for all of the various providers,” he said.

Before Magellan officially took over the contract, Charron said Magellan and Health and Welfare worked to make sure they were prepared for the transition – and they had to prove that to federal regulators at the Centers for Medicare and Medicaid.

“From the state’s perspective, we saw that Magellan was very prepared,” she said.

“I’ve been through a number of managed care rollouts personally in my professional career, and there are always those unforeseen things that can happen,” Charron said. “… I think what matters is how quickly the plan and the department can resolve it and get it fixed so that it’s not impacting participant services, and care, and provider experience, provider reimbursement.”

Checks are in the mail

Until September, Magellan sent providers payments by mailed checks – in response to a hack into a national payment system. Providers say they didn’t receive some of those checks.

Charron says she was on some emails from providers complaining about missing checks. And she said she saw Magellan leadership offer to overnight mail the checks.

Before Magellan transitioned to electronic payments, some providers got prepaid debit cards as payment. When Magellan learned that some providers were charged extra fees to access the cards, Charron said the company fixed it.

“Magellan is a national entity, but we wanted them to be Idaho-based – understand what it means to be an Idaho provider in (a) rural community or in our more urban areas, to understand the geography of our state and how people access care, or navigate care. And I feel like they’ve really taken that seriously,” Charron told the Sun.

Since Scott’s first payment in October, she said she’s received more from Magellan, but it’s been a few hundred dollars at most each time. Over four months into Idaho’s contract with Magellan, Scott said she’s still short thousands of dollars in payments for patients she’s treated.

As the only employee in her clinic in Nampa, she handles billing and treats patients, she told the Sun.

“It was already hard enough. And then to have everything – just sort of, all of my income, just dry up in July – was really brutal,” Scott told the Sun. “But Magellan has been very kind, and very helpful. I’m really grateful for that.”

One evening, she said a Magellan billing staffer helped her realize that her modifiers on billing claims needed to be different – one of several billing issues she’s ran into.

In an interview three days before Thanksgiving, she said she was told that almost $5,000 in direct deposits were on the way. Some were set to arrive Wednesday, she told the Sun on Tuesday afternoon.