A Portland-Vancouver-area company and the Washington state agency that oversees social services have largely resolved a dispute over a new computerized statewide billing and payment system for Medicaid.
At issue was ProviderOne, the Washington Department of Social and Health Services’ $164 million computerized system for handling millions in payments for medical and nursing home care to thousands of health care providers, including doctors and pharmacies.
Leaders of Portland-based Care Medical & Rehabilitation Equipment, whose Vancouver office represents about 20 percent of the company’s sales, publicly complained that monthly revenue from Medicaid billings dropped drastically because of glitches with ProviderOne. The company also said it wasn’t the only provider of medical equipment whose bottom line was hurt because of delays and other problems with the system.
While state officials acknowledged ProviderOne had bugs early on, they responded to Care Medical’s complaints by saying the company needed to improve its ability to file claims with the system.
A turning point in resolving the dispute occurred in October, when Care Medical and DSHS staff met to discuss the problems and to walk through the ProviderOne system, according to Cathie Ott, assistant director of systems and monitoring for DSHS. “They certainly recognized the errors they were making on their side and the work they needed to do to correct it,” Ott said.
Robert Lee, director of government affairs and health policy analyst for Care Medical, said “everything is going much more smoothly now.” He referred additional questions to Angelene Adler, vice president of operations for Care Medical, which employs 350 people in Washington and Oregon. Adler could not be reached for comment.
However, in a Nov. 8 letter to Doug Porter, assistant secretary of DSHS, Adler thanked the agency for its help. Without that assistance, she said, “we would have been forced to make drastic business decisions.”
Adler wrote that the company is taking steps to correct issues that were brought to its attention. She added that the company hoped “this experience doesn’t divide us” but instead brings Care Medical and DSHS closer “for the betterment of those communities we mutually serve.”
Karen DeLeon, the state agency’s chief of Medicaid systems and data, said Care Medical is “getting more claims paid. We’ve made some good progress.”
DSHS launched the first phase of the ProviderOne system in May. It replaces a 32-year-old payment system for Medicaid, a shared state-federal health insurance program that serves low-income parents, children, seniors and people with disabilities. The new system software is intended to reduce errors, overpayment and fraud, and to reduce paperwork by offering user-friendly, online services.
