Blue Cross blames computer upgrades
Doctors, hospitals and other providers aren’t getting paid for the care they deliver to a quarter-million state employees and retirees insured through the Office of Group Benefits.
Blue Cross and Blue Shield of Louisiana recently took over, in a private contract, the management of the agency that had overseen health care coverage for state employees and retirees.
Blue Cross notified the state by letters that payments would be delayed while computer programs were upgraded.
Patients should not be affected, according to Blue Cross, but physicians and health care providers may not get paid for six to eight weeks.
The computer alterations deal with health plans benefit changes made by the state agency and were finalized Dec. 11, according to a letter from Brian Keller, a senior vice president of Blue Cross and Blue Shield of Louisiana.
Blue Cross also partly blamed adjustments needed to comply with the federal Affordable Care Act.
Greg Waddell, director of legal affairs for the Louisiana State Medical Society, said the payment delays are going to pose a cash-flow problem for some physicians who bill weekly or biweekly.
“Four to six weeks to get claims paid, that can become problematic,” Waddell said. “The other obligations of a physician’s office don’t get put on hold.”
Blue Cross asked the Jindal administration for a waiver of penalties that would normally be due for untimely payment of claims.
Blue Cross got a state contract in late 2012 to manage Group Benefits’ preferred provider organization, health maintenance organization and Consumer Driven Health Savings Account.
The plans cover about 250,000 current and retired state employees and their families, most of whom live in the Baton Rouge and New Orleans areas.
Paying the bills submitted by doctors and other health care providers had been handled by employees of the state agency Office of Group Benefits.
“We are working closely with (Blue Cross/Blue Shield), and if this impacts Blue Cross’ ability to meet its performance standards for claims processing time as required in their contract, we will apply the appropriate penalty,” wrote Doug Baker, a Jindal administration spokesman, in an email response.
Blue Cross and Blue Shield of Louisiana’s communications chief, John Maginnis, also blamed the Affordable Care Act mandates, though that was not mentioned in Blue Cross’ initial letter seeking a waiver of contract requriements.
“There are many, many things that have to be done to bring all our customers into compliance with (the Affordable Care Act). OGB is not the only area that has challenged us,” Maginnis said. “It’s a very difficult situation for all health plans.”
Blue Cross’ request for delay came in a Dec. 30 letter from Keller to Charles Calvi, the chief executive officer at the Office of Group Benefits, in which he outlined the problem meeting contract requirements.
“The requested benefit changes for 2014 are variations of the member out-of-pocket maximums and will require significant work by our teams to build, test and deploy,” Keller wrote. “The requested changes will likely take 6-8 weeks before we can accurately process claims. During this time period we feel it necessary to delay claims payments for services rendered in 2014.”