Medicaid providers knew that the rollout of the state’s new Medicaid billing system would be rocky, but many say the issues are bigger than they were led to believe, and some say it’s affecting their businesses.

By Rose Hoban

After two weeks of frustrating phone calls, an estimated 20 hours on hold and error messages telling her she had submitted her claims incorrectly, Kathy Tobias got in her car and drove from Sanford to Raleigh.

Her mission: to get to the bottom of why the health care company she works for wasn’t being paid by NCTracks, the new Medicaid computer system that rolled out July 1.

It’s been about three weeks since the launch of NCTracks, the state’s new Medicaid-management information system – which took two years longer than anticipated to complete, with a more than $200 million cost overrun –  and users such as Tobias are frustrated.

“It took a week to be able to get on the system at all,” said Tobias, an accountant for a company providing in-home personal care services for people with disabilities.

Eventually, the system allowed her to submit a bill for one service, but, despite numerous efforts, wouldn’t accept her claims for another.

Over the course of two weeks, Tobias estimates she spent about 20 hours on hold. She then launched a Facebook page for people having problems with the system.

“It’s a system error,” “it’s a problem in your software,” “you may have a virus” and “please be patient” were among the responses Tobias said she received.

“Well, that’s all fine and good,” she said, “but when will we get paid?”

That’s what prompted the car ride to NCTracks’ offices on Wycliff Road in Raleigh.

“I was seen in five minutes,” Tobias said.

It turned out that for the service she was unsuccessful in submitting claims for, NCTracks required that she enter her company’s street address, rather than the post office box she used for other claims.

“My problem is fixed,” she said. “But someone who is not as aggressive as me, how much can they take?”

Tobias is fortunate. Dentist David Galatas, who has offices in Fayetteville and Spout Springs, estimates he’s currently owed about $50,000 in back payments because he can’t get the system to accept his billing.

He hasn’t been paid for any Medicaid-covered services since late June.

“We were trying to do what we needed to do to make the transition smooth,” Galatas said. “But at this point, this was a waste. And they won’t compensate me for the time that I spent sending my office manager to the trainings and for the time she’s spent on the phone.”

Hold on

In January 2012, state Auditor Beth Wood released a scathing audit on the progress of the new Medicaid computer system – a project years in the making. At the time, Secretary of Health and Human Services Lanier Cansler said that many of the delays in the project were the result of constant changes – in state laws, from the Affordable Care Act, in new federal regulations – that needed to be programmed into the system.

In the end, the project, which went to bid in 2007, was delayed more than two years, with at least $230 million in costs overruns.

When she arrived in Raleigh, Aldona Wos, who succeeded Cansler, said she looked at the state of the project and thought, “There is no option; just get it over the finish line.”

To complete the project, Wos hired a chief information officer, Joe Cooper, who came from the banking industry.

“We are going to push it over July 1, and we are going to pull it over to July 2, and by January we will be kind of OK,” Wos said in an April interview with North Carolina Health News.

DHHS reported in a Friday press release that the system has paid out $351 million to providers and processed about nine million claims. Calls for comment were not returned.

Meanwhile, the department is making a push to satisfy users. The NCTracks call center stayed open on Saturday to accommodate a backlog of calls.

“Call volumes and wait times are likely to remain elevated in the near term,” Cooper said in the press release.

According to the release, the call center is averaging about 2,500 calls daily and problems are being handled in anywhere from 2.5 minutes to 2.5 hours.

Lowering expectations

Prior to the launch, DHHS officials tried to prepare health care providers for a rocky road.

“It is important to set realistic expectations about what is going to happen as we transition to the new system,” Medicaid head Carol Steckel wrote in a June 27 op-ed. “We know from the experiences of other states that have implemented Medicaid payment platforms that there will be an initial rough patch of 30 to 90 days as providers get used to using the new system.”

“Despite thousands of tests being run on the system, we will likely uncover additional changes that need to be made after we go live,” she wrote.

Steckel also indicated that only a small percentage of providers had taken advantage of training classes and online modules to prepare for the new system.

“It would have been my recommendation that they rolled it out later,” said Joey Lambert, an IT consultant in Sanford who works for a number of doctors’ offices using NCTracks.

Hold times for technical support need to be shorter, he said, “and if there are problems resolvable by technical means, they should publish an FAQ on the site.”

At least a dozen FAQs are currently available on the NCTracks site, but Lambert said there are more problems than there are answers.

He said clients ranging from nursing homes to prenatal clinics to dental offices have had problems getting claims filed and getting paid, and have spent hours sitting on hold.

Lambert said he believes the department should have continued testing and fixing bugs before launching.

Patience wearing thin

Her problem having now been solved, Tobias said she’ll try to be patient.

“I’m not opposed to change, and the old system was cumbersome,” she said. “I think it’ll be really nice once everything is up and running.”

But others said their patience is running out.

Cathy Midgette said she approached the edge of desperation in her attempt to get her son’s seizure medication.

“It’s been a flipping nightmare,” said Midgette, whose son has had a seizure disorder since he was 23 months old and had meningitis. He is now profoundly developmentally disabled.

She said she spent days on the phone with NCTracks and at the pharmacy trying to get prescriptions filled for a drug her son’s taken for years. Without them, he has seizures and she has to take him to the hospital.

His medications cost more than $1,000 a month, something Midgette said she can’t cover while she waits for the system to get fixed.

Eventually, she called the office of Sen. Bill Cook (R-Chocowinity), who represents her. His assistant called DHHS, and Midgette soon received a call that resolved her problem.

Cook’s aides said they’ve had calls from other constituents who are having problems with NCTracks.

According to a blog on the N.C. Medical Society’s website, the “worst case scenario of a total failure of the system did not come to pass.” Nonetheless, the society is receiving 20 to 30 entries a day on a trouble log, and those entries indicate that people are angry.

“I’m a 30-year IT veteran. I’ve seen lots of things with medical filing, and I have a lot of clients who file for Medicaid reimbursement,” Lambert said. “Anyone who files Medicaid has had issues.”

“I know the state has a big job on their hands,” he said. “By the same token, these things should have been ironed out.”

Crystal Matthews, the office manager for dentist David Galatas, said eventually her office was able to upload X-rays to get approval for more complicated dental work, and some things are slowly getting resolved.

“But I feel like there’s no resolution until we can get claims paid,” she said.

“You expected problems for a couple of days, but not two weeks later,” said Matthews. “And did they sugar coat how things are going? Yes, they did. As far as we’re concerned, it seems like they did.”

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