Many providers not prepared for MaineCare shift

By Meg Haskell, BDN Staff
Posted Nov. 17, 2009, at 11:38 p.m.

Health care providers are dragging their heels about signing up with the state’s new MaineCare computer-based billing and information system. Only about half of all enrolled providers — including hospitals, doctors, dentists, social workers, chiropractors, physical therapists and others — have registered with the new Maine Integrated Health Management Solution system, or MIHMS.

According to Brenda Harvey, commissioner of the state Department of Health and Human Services, failure to enroll by the Dec. 23 deadline means providers won’t get paid for treating Mainers who are covered by MaineCare, the state’s Medicaid program for low-income and disabled residents.

“It is really very critical that they re-enroll,” Harvey said. The re-enrollment process has been open since July, she said.

MIHMS is on tap to replace the ill-fated Maine Claims Management System, or MECMS, which went live in January 2005 and immediately malfunctioned, sending MaineCare providers and the state MaineCare office into financial and administrative chaos. After months of trying to fix the multiple interrelated problems within the system, officials announced MECMS would be scrapped and eventually replaced. For the past three years, the largely disabled system has been processing and paying provider claims, but not gathering and reporting essential program data as is required by the federal government. The new system is designed to perform all needed functions.

Harvey said it is unclear why providers have not been signing up.

“The initial rollout [of the re-enrollment process] started with a real bang,” she said. “Then it just seemed to stop.” Of the approximately 4,500 providers participating in MaineCare, only about 40 percent have re-enrolled, she said, despite a series of hands-on workshops, a provider telephone help line and even an instructional video.

Andrew MacLean, Maine Medical Association vice president, said Tuesday that doctors may be feeling wary of the new system, given the MECMS debacle. Doctors may also be simply procrastinating, he said, putting off the “hassle” of the enrollment process.

But he said physicians are unlikely to take a deliberate stand against participating in MaineCare.

“Most doctors appreciate the role of MaineCare in the health care system,” he said. Especially in more rural areas of the state, he said, providers cannot realistically expect to stay in business without taking part in the program.

At the Maine Dental Association, Executive Director Frances Miliano said the state has worked hard to persuade dental practices to re-enroll.

“I really give them high marks for trying to keep providers informed,” she said. Some dental groups have experienced problems with the re-enrollment process, she said, but others are probably just putting it off.

“People are concerned, having gone through the collapse of the old system,” she said. “There is some lack of confidence that the new system is going to work.”

Harvey said she understands a degree of provider skepticism.

“The MECMS experience is still in recent history and it was an awful experience for providers and for our staff,” she said. The new system, she said, is already being tested to be sure it will work correctly, but comprehensive testing cannot occur until all participating providers are signed on.

The state will continue to press participating providers to re-enroll as soon as possible, she said, with e-mail reminders and personal phone calls. One-on-one assistance is available, she said.

The new MIHMS system, designed by the Unisys Corp., will cost an estimated $54.6 million, with the state responsible for about $6 million and the federal government paying the balance. It is scheduled to take over MaineCare billing, reporting and other functions on Feb. 28, 2010.

mhaskell@bangordailynews.net

990-8291

http://bangordailynews.com/2009/11/17/news/many-providers-not-prepared-for-mainecare-shift/ printed on August 30, 2014