APD >Update on EDS Provider Payment Issue

• The new Florida Medicaid Management, Information System went live on June 26 after two years of design, development and testing by both EDS and AHCA.
• In preparation for the transition, more than 400 training workshops were provided to more than 14,000 stakeholders, such as health care providers, third-party billing agents, provider associations, state agencies and others between November 2007 and June 2008.
• Since the go-live date, EDS has processed about 5 million provider claims and several million eligibility verifications. More than $640 million in payments have already been made in July and we are on track to issue a total of about $1 billion in provider payments by the end of the month.
• Many providers have experienced issues with the transition to the news system:
  
  
  Telephones:
  
  
  • As is to be expected with a new system, we have received as a large number of calls from providers, billing agents and Medicaid beneficiaries; they are of longer-than-normal duration and as a result have frequently blocked other in-coming callers.
  • EDS began the transition with approximately 150 phone lines in place and has since doubled the number of lines available to over 300 and added additional staff to address these capacity issues.
  • Hours have been extended to 7am to 8pm Monday through Friday and Saturday 10 to 4. Providers are encouraged to call in the evenings and on Saturdays.
  • We are monitoring progress and will ensure that EDS takes the steps necessary to provide the highest quality customer service to callers.
  
  
  Payment delays:
  
  
  • The vast majority of claims are being processed quickly and accurately. However, a significant number of providers and billing agents have experienced problems in getting paid due to data processing errors - some by providers and some by the system. There are over 5 million lines of code in this new system – virtually impossible to avoid some level of edits/changes after implementation.
  • Primary areas affected have been payments to waiver providers, the resolution of suspended claims, eligibility verification for recipients with multiple benefit coverage, and Medicare crossover claims.
  • To address the providers’ short-term financial needs, AHCA has authorized emergency payments. In the meantime, EDS engineers are working with AHCA around the clock to resolve the remaining payment issues.
  • The delays are being resolved:
    
    
    • Processed more than 45,000 claims totaling $590 million dollars.
    • Processed approximately 5,600 additional interim payments to providers outside of the regular payment cycle in response to individual issues.
    • Of the 8,000 Medicaid Waiver providers, more than half are successfully submitting claims and receiving payment.
    • For the remaining waiver providers who are having difficulties, interim payments should reach them today covering 85-90% of what they were paid the previous month to ensure that there is sufficient cash flow for their businesses.
  
  
  
• How can a provider get help if needed?
  
  
  • Providers first call should be to 1-800-289-7799, the main help line
  • A "common issues/faq" document is posted on the website (www.mymedicaid-florida.com) and updated daily. An on-line training tutorial is also available.
  • Interactive Webinars are in the works, schedules will be available soon.
  • Providers who have continuing issues should call their area Medicaid Office; staff there can escalate their request to the joint triage team which has been established to identify critical issues. Contact information for the area offices is at www.ahca.myflorida.com or at the fiscal agent site referenced above.



• How long until the system is operating normally?
  
  
  • Significant progress is being made each day that moves us closer to standard operations.
  • We expect to have all the issues identified within the next week, and EDS staff are working literally 24 hours a day 7 days a week to resolve the outstanding issues. Our hope is that major issues affecting providers will be resolved within the next several weeks.



• We are acutely aware of the challenges these issues are presenting for some providers, and we are focused on resolving these issues as quickly as possible. This system is replacing a 20 year-old platform that was antiquated and didn’t meet the needs of today’s Medicaid program. The new system will provide tremendous benefits for all Medicaid stakeholders, and most importantly will help us better serve our beneficiaries.