Maine Medicare system fraught with problems

State trying to roll out fixes in releases over a year but in a release last month, more problems were discovered.
Written by Richard Koman, Contributor

Maine's Medicaid billing system has been wreaking havoc since January 2005 and final upgrades won't be complete until next summer, the Bangor Daily News reports, at a cost of $56.3 million.

According to Brenda Harvey, commissioner of Maine's Department of Health and Human Services, the computer system is currently processing correctly upwards of 90 percent of new claims from the thousands of doctors, dentists, therapists, home care providers and others who provide services through MaineCare, as the state's Medicaid program is called. But that means that up to 10 percent of claims are not processed correctly, adding each week to the more than 180,000 claims that remain unresolved from earlier failures.

At the situation's worst point, Harvey said, more than 600,000 claims were "suspended" and awaiting resolution. The majority of these have been processed over the past months as changes to the computer system have been made. Claims currently in suspension will be resolved as the computer system is reconfigured to process them appropriately, Harvey said. "There are still some fixes to put in place," she said.

The state is planning half a dozen releases of related changes over the next year. But the first release, last month, revealed so many problems that further releases have not yet been scheduled.

The July release specifically sought to repair computer functions related to the paying of what are known as "Medicare A crossover" claims - that is, hospital charges for low-income, elderly Mainers that are not paid by their Medicare Part A plans, such as co-payments or deductible amounts. For people with both Medicare and Medicaid coverage, MaineCare pays charges not covered by Medicare.

"Some hospitals still had difficulty getting paid," Harvey said of last month's release. "But now we think the computer problems have largely been resolved."

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