February 26, 2010

Update on Provider Payment Delays

Care Wisconsin uses an external third party administrator (TPA) to process claims submitted by contracted providers.  In 2009, we made the decision to move to a new TPA and a new processing system that could handle the larger number of claims from nearly 3,500 providers serving our 4,000 Family Care/Partnership members.  This transition occurred effective November 1, 2009. 

Care Wisconsin did not anticipate all the complexities of a systems conversion this large, and there have been a range of obstacles in the technical transition to the new TPA.  As a result, some providers are experiencing delays in payments for services.

In some cases, these delays have caused hardships for providers.  We acknowledge that Care Wisconsin is responsible for these payment issues and apologize for the difficulties providers may be experiencing.

The sole reason for the payment delays is the technical problems associated with the conversion to the new claims processing system and TPA.  Care Wisconsin continues as a strong partner with the State in bringing Family Care to the frail elderly and adults with disabilities and ensuring the elimination of waiting lists.

When will Care Wisconsin return to normal processing of claims?

Care Wisconsin has committed to a return to normal claims processing by the end of March.  By then, Care Wisconsin will be processing and making payments on claims within 30 days of receipt of a claim.

First, we’ve focused on clearing up the claims backlog for November and December 2009.  Now, we are working on timely payment for January dates of service.  In fact, providers are receiving payment for January claims already. 

By the end of March, we will be making payments on claims within the normal 30 days of receipt of a claim.  This means that provider claims for February services will be paid within 30 days. 

What is Care Wisconsin doing to prevent this from happening again? 

We’re learning a lot from this difficult transition to a new claims processing system and making changes that will prevent the same problems from happening to claims coming in the door in the future.  We’ve been working closely with our TPA on correcting the internal claims set-up and finding ways to help the claims flow through the system faster.  Both Care Wisconsin and the TPA have beefed up their staff and added extra resources to address all these issues.

We are committed to returning to the normal and timely processing of claims that our providers experienced in the past.  Prior to this conversion, Care Wisconsin had been working with its Partnership Program providers in Dane County since 1995 and provided consistent and timely payment of claims.

Again, we are sorry for any difficulties, and we thank all providers for their essential role in serving members in our Family Care and Partnership programs.

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