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April 17. 2013 9:56PM

NH officials say new Medicaid computer system improved

CONCORD - An eight-year long project hit a snag when the state's $90 million Medicaid computer system went live April 1, as some providers received overpayments and others had claims rejected.



Health and Human Services Commissioner Nick Toumpas said Wednesday the new system has much tighter controls so claims that may have gone through the old system do not go through the new one.

The new system will suspend those payments and the claim until a review is done he said.

"It's simple things. For example, somebody may have submitted it with the Legacy system provider number. We've had a lot of those," Toumpas said. "So when they submit their claim and they have the wrong number on it, or their wrong number, it's going to get kicked out."

New edits also kick out claims as though they are not valid, he said.

He acknowledged that some providers could interpret that as a delay.

In 2005, the state began the project to upgrade the system to process Medicaid claims and pay providers at a cost of $60 million, then the largest contract in state history.

The system links more than 10,000 health care providers with the state to process the claims for more than 130,000 Medicaid recipients.

The company that won the contract over long-time system operator Electronic Data Systems, Affiliated Computer Systems, soon ran into problems and the start date was pushed back, the first of many delays.

Affiliated Computer Systems has since been acquired by Xerox.

The delays caused frustration for state officials since the first deadline in 2007 was missed along with eight others since then.

EDS, now owned by Hewlett-Packard, continued to operate the system until April 1.

Xerox hopes to use New Hampshire as a model to attract business from other states.

Explaining some overpayments to providers, Toumpas said a contingency plan was developed because the old system was shut down in the middle of March meaning providers were not paid for several weeks.

He said the department sent letters to the providers so they could obtain a transitional payment to bridge the gap.

"What we've seen is that some of the small providers had problems with the suspending of the payments," Toumpas said. "It was unclear if it was their problem, whether they submitted something incorrectly, or whether it was getting kicked out legitimately."

He said the department did not want to put providers at risk by holding up the payments so additional contingency payments were made with the understanding the state could get the money back after the claims and payments are reconciled.

"By and large for the first two-plus weeks of the operation, it has gone remarkably smoothly," Toumpas said. "There are issues that any system you roll out is going to have."

grayno@newstote.com


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