MCO Issues

 

Ref:       Providers’ Experience issues with MCOs

From:    Vickie Guarraci

MLTSS is over two years in progress and Providers are still experiencing operational/procedural and payment issues with the MCOs.  While some MCOs perform better than others, there are still hurdles that must be jumped and obstacles that need to be removed.

While Providers address these issues on a daily bases; to effectively make changes it needs to be confronted by a higher level that can mandate improvement and create uniformity in the administration of Medicaid benefits and payment to Providers.

As a result, we are compiling a list of experiences/events that our Providers are continuously encountering.  These experiences can be issues such as in the areas of:

• Patterns of claim issues
• Authorizations
• Obstacles to admissions
• Failure of MCO response to Member issues
• Inability to obtain services for residents
• Failures/inefficiencies with local Medicaid offices.

Please provide specific scenarios that we can identify as operational and/or payment trends occurring among all or individual MCOs.  While we are aware of many events that are occurring, there may be others that we are not aware of.  Please ask your staff for their in-put in providing information.

We request that you submit all information directly to Erica at [email protected] by Tuesday, September 6th. 

Thank you for your cooperation as we work to facilitate improvements in the MLTSS program.