Nevada Medicaid case backlog won't be cleared soon

CARSON CITY (AP) - Nevada Medicaid officials say a plan to have cleared a backlog of more than 170,000 unpaid claims by July 1 now appears unlikely.

Computer problems caused delays for the state agency responsible for paying doctors' claims, some dating to October. The Nevada Division of Health Care Financing and Policy still is working to pay claims from October to December, which must be processed manually because of the glitch, said administrator Charles Duarte.

Duarte on Tuesday said the agency's contracted provider, First Health Services, was moving at a pace "slow for our liking." He added the provider will face penalties for overdue claims beginning July 1.

Duarte plans to discuss the issue at a Friday meeting of the state Board of Health in Carson City.

Doctors are hopeful that Medicaid will start paying doctors in a more timely manner, even after the state failed to meet deadlines in March and April for catching up with the workload.

"In January we realized there was a (computer) problem and by March we realized the problem was much bigger than anyone previously had thought," said Larry Matheis, executive director of the Nevada State Medical Association. "It was just a colossal set of problems."

Matheis said he has had weekly meetings with state Medicaid officials for 20 consecutive weeks trying to hammer out a solution. If the matter isn't quickly resolved, he said it could result in doctors dropping Medicaid patients, which include numerous poor families, especially children.

Matheis also said doctors are hesitant to file claims until they are sure the computer system will accurately process them in a timely manner.

Recently, the legislature's Interim Finance Committee approved taking $20 million from Medicaid's $1 billion 2005 fiscal budget, to cover an end-of-fiscal-year shortfall and pay doctors what they are owed.


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