April 5, 2010

Claims Processing Returns to Standard
30-days or Less Timeframe

On March 31, 2010, Care Wisconsin met its goal of returning to timely payment of new claims within the standard 30-days or less timeframe.  We continue to work closely with both our third party administrator (TPA), who processes claims, and our network of 3,500 providers as we monitor the claims processing system and ensure that claims are being correctly processed.

In the weeks ahead, Care Wisconsin will be making arrangements with certain providers who received advance payments for November and December 2009 dates of service for repayment.  Issuing advance payments was one of the extra steps that we took to make sure that providers had funds in hand while claims processing issues were being resolved.

Last fall, Care Wisconsin contracted with a new TPA for claims processing and converted to a robust claims processing system capable of handling an increased claims volume, automated claims adjudication and cost-effective processing.  We did not fully anticipate all the complexities of this large-scale systems conversion, which resulted in claims payment delays due to technical problems.

Thank You to Providers

Care Wisconsin acknowledges and apologizes to providers for the hardships caused by the claims system conversion.  We truly appreciate our providers for their patience and support during this difficult time.  Most importantly, we are thankful for the services and quality care that they provide to our Family Care and Partnership members.

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