Processing Idaho Medicaid Claims

Oct 5, 2011

BOISE, Id – Idaho’s new Medicaid processing system is getting better.  That’s the word Tuesday from the Department of Health and Welfare to a group of lawmakers.  The company that handles the system has worked to improve its track record, after a bumpy start last year.

Molina Healthcare took over the claims processing system for Idaho’s Medicaid Program last June.  That system pays out 24-million dollars a week to more than 10-thousand medical providers.  But when Molina took over, the company was understaffed and not prepared to handle the volume of claims.  Thousands of claims went unpaid.  Small providers were close to bankruptcy.  Even getting someone on the phone at Molina was a challenge.  Leslie Clement is a Deputy Director in Idaho’s Department of Health and Welfare.

Leslie Clement “You can see when the system first went up, the abandon call rate was fifty percent, that’s just absolutely a horrible performance, you can also see that for those that hung in there and waited for someone to answer the call, they were waiting over 38 minutes, that’s unbearable.”

Molina admitted it was understaffed and added forty people to its Idaho operations.  Over time, Clement says performance has steadily improved.

Leslie Clement “The abandonment rate is less than two percent, the amount of time people have to wait until someone answers the phone is thirty seconds, that’s a real good sign on improved performance.”

Molina’s performance could affect the state’s budget.  Idaho’s claim system still needs to be certified by the Centers for Medicare and Medicaid.  If it’s not, the state would end up owing Medicaid a lot of money.

Leslie Clement “The bottom line is that for every month that the system is not certified, that gap is 450-thousand dollars in state general funds.”

Clement says if Molina can’t get certified for the past year the system has been in operation, the state will hold Molina responsible for the extra costs.

Copyright 2011 BSPR