Many behavioral health providers have been unable to process bill payments for Medicaid clietns since March 1, when the state launched the privately managed Louisiana Behavioral Health Partnership with contractor Magellan Health Services. Magellan, which landed the contract to coordinate behavioral health services statewide in September, uses a web-based system called Clinical Advisor, described on the Department of Health and Hospitals' (DHH) website as "an electronic behavioral health records (EBHR) computer program."
It's also the mechanism through which clinics submit Medicaid claims. And it hasn't been working according to this press release posted by the Guidance Center, a mental health rehabilitation (MHR) agency in St. Bernard Parish (emphasis added):
As of March 7th, 2012 The Guidance Center, Inc. (TGC), an Outpatient Behavioral Health Agency, has delivered over 800 hours of service to Medicaid clients. We have not been able to input our service notes into the Magellan Clinical Advisor. Other providers across the state are reporting the same problem. As a result, neither Magellan nor DHH can provide oversight of services being provided to Medicaid members, nor is there any mechanism for timely payment to providers for services delivered.
“Nobody’s been able to bill," says Elias Hanusiak, who works for Enhanced Destiny Services, an MHR in New Orleans. "It's simply that the system isn’t 100 percent ready to go.”
Hanusiak, and others interviewed by Gambit, report problems with Magellan's online billing system ranging from passwords not working to being unable to enter required information like client medical records and diagnoses.
“Basically, on March 1, Magellan was supposed to go online and everything would be great, right?” says an employee at another New Orleans MHR agency who preferred not to be named.
She says Magellan has introduced new billing codes — known as current procedural terminology codes and used to determine how much a provider should be reimbursed for a service — that in many cases don't seem to apply to the actual services these providers offer.
Services formerly coded as "counseling" or "community support" no longer go by those names under the Magellan system, she says. Actual services haven't changed, but employees weren't told what the new codes were going to be before implementation.
“It wasn’t until an hour ago that I was told what codes to bill,” she says.
Providers do report that Magellan has been extremely responsive and helpful in trying to deal with their complaints. DHH Deputy Secretary Kathy Kliebert tells Gambit that the company has been working closely with the providers.
“Magellan has recognized there are some issues working with the clinical advisor," says DHH Deputy Secretary Kathy Kliebert. Kliebert says MHR agencies have been the only type of mental health providers that have reported billing problems. “Magellan has beeen working individually with these providers."
MHRs haven't yet seen an actual interruption in payments. They received their last direct Medicaid payments, from a pre-March 1 billing cycle, on March 6. To make sure that these companies don't lose money, Magellan, she says, plans to give them an advance payment on Monday, March 12.
“It will be based on the historical claims that they’ve had. They did receive claims from Medicaid on March 6, so they won’t have an issue with cash flow,” Kliebert says.
Hanusiak says Magellan officials said today in a conference call that the web site would be fully functional by Monday ("Tuesday at the latest," Hanusiak says Magellan added), which Kliebert confirms.
“They’re really trying, but they’re really taking their sweet time," Hanusiak says. "It's a learning curve issue, on both ends."