The companies that manage care for Louisiana’s Medicaid recipients say they have fixed an issue that state auditors found resulted in the payment of $10 million in claims that didn’t adhere to a new state law requiring certain tracking numbers.
Legislative Auditor Daryl Purpera wrote in a recent report the state paid out the $10 million in behavioral health services claims despite the fact the claims did not include a National Provider Identification number for the individual providing the service.
Kathy Kliebert, consultant with the Louisiana Medicaid MCO Association, said some of the systems put in place by the managed care organizations to adhere to the new law, which went into effect Jan. 1, had problems. Many of the problems were “technical” glitches, she said.
All of the MCOs’ “encounters”--the services provided--were reviewed and the organizations have re-processed the impacted claims that resulted, Kliebert said. The MCOs have also taken corrective measures to prevent the issue from happening in the future.
Before this year, providers could list the National Provider Identification, or NPI number, of their business, rather than the specific individual providing the service. A new state law changed that, requiring the individual NPI be listed. Purpera’s office wrote the new standard makes it easier for the state to track claims.
“Identifying who specifically provided the services is important in order to identify improper payments and potential fraud,” the audit said.
The $10 million in claims represented 40 percent of the total amount of claims paid by the MCOs for psychosocial rehabilitation and community psychiatric support and treatment services during the time period examined, from Jan. 1 to March 31 of this year.
The MCOs sent the corrected claims to the Louisiana Department of Health earlier this month.