2 Enid mental health facilities report not getting money from Oklahoma Health Care Authority

Officials with two Enid mental health facilities say they are not being paid by Oklahoma Health Care Authority since they hired a new company to process claims.

Joyce Beam, of Choices Institute, and Rebecca Livesay, of Associated Therapeutic Services, said they contract with OHCA to treat individuals whose treatment is paid through Medicaid. Officials with the new company, OptumHealth, assured them there would be a smooth transition, but Beam and Livesay said claims are either not being paid or being partially paid. Checks have been lost, and OptumHealth has denied some claims, which never have been denied before. Livesay said some of the reasons have never been explained.

The company pays Medicaid and Sooner Care claims. The contract was effective Oct. 1, but there have been problems with the system dating back through September, Beam and Livesay said. They said the problem is statewide.

“They are not paying the amount of the claims and they are denying some claims. That means people we contract to work with those clients are not getting their income,” Beam said.

Oklahoma Health Care Authority issued a public statement regarding the problem, saying it has identified an obstacle dealing with reimbursement to some behavioral health providers.

“We are aware of the issue and are already in the midst of a solution. It is a top priority of the OHCA to address the issue immediately and to ensure that our providers are paid timely and appropriately,” the statement said. It is dated Oct. 14.

The procedure is for the treatment facilities to submit a treatment plan to the state for each client. They cannot be paid until the plan is approved, and some are not yet approved. Beam, whose facility treats children, said some need intense treatment and she cannot ethically cease treating them, but is not being paid for it.

Beam said claims have been denied, then denied for a different reason the following week.

“Sometimes we send claims to the state and it is missing,” Beam said. “Sometimes a client will have three claims and they will approve only one.”

Livesay called it chaos. OptumHealth has changed all codes, which has led to sporadic acceptance of claims. Choices deals with youth who recently have come from a mental health hospital, and some of the treatment takes up to 15 hours a week.

“If we can’t treat them they will return to the hospital. It’s $40 a day for treatment and $1,500 a day in the hospital,” Beam said.

Livesay said last week she was paid for only 17 percent of her billing and has never been notified why the claims were not paid. She said the process hurts contract counselors the most.

Behavioral health is only a small part of the overall health care system budget. Meeting the changing requirements for submitting claims and finding why claims were not paid or were lost requires much more time and work by those who the clinics hire to perform bookkeeping, Livesay said. That, in turn also is more costly to the mental health suppliers.

“It’s getting to be huge amounts and as it continues it gets more dangerous for all clients and for our businesses,” Livesay said.

She said she has not contacted any Enid area legislators for assistance, but they have been helpful in the past.

Both Beam and Livesay said they only are receiving about 20 percent to 40 percent of what they bill out. They are not part of the Department of Human Services, although they work closely with DHS.

“I thought it would get better, but it’s getting worse,” Beam said.

“It has quadrupled the paperwork required,” said Livesay.

OHCA’s statement said a competitive bid was awarded to OptumHealth, a behavioral health management system, with the responsibility of determining medical necessity and processing behavioral health claims through the prior authorization system. Unfortunately, the transition period to a new system led to some difficulties in processing prior authorizations, the statement reads.

The statement said the problem is caused by a software problem.

In the short term OHCA, to minimize the impact, made an estimated payment for October services, based on the providers’ average monthly payments for the past three months. Livesay said the payments were less than they should have been.

In a prepared release Wednesday, OptumHealth officials responded by saying they are working quickly to fix software-related issues with the electronic authorization system.

“OptumHealth is committed to supporting Oklahoma’s behavioral health providers as they guide the people they serve to long-term recovery. While we work quickly to fix software-related issues with the electronic authorization system, providers having problems using the system can fax their requests to OptumHealth at (855) 543-5921 to receive a prior authorization. This will allow the Oklahoma Health Care Authority to pay providers in a timely manner. Any provider needing help with a prior authorization submission can call us for assistance at (800) 854-0833,” the news release stated.