Anna Twomey, Senior Solutions Engineer, Americas Blue Prism, Albert Nguyen, JD, CSM Associate Director Bits In Glass
In the months since COVID-19 hit the U.S., millions of Americans lost their jobs, along with health care benefits, prompting an unprecedented surge in Medicaid claims. Newly uninsured patients needed to be tested or hospitalized amid the Coronavirus pandemic. States and local agencies faced intense pressure to serve their constituents’ needs, but were quickly overwhelmed by the number of claims, antiquated systems and ever-changing coding requirements. As a result, few claims are processed quickly or efficiently. The Challenge
While funding was made available, many claims are incorrectly coded, and patients and providers face lengthy delays. With claims rejected or denied, the backlog not getting processed is insurmountable. Doctors are not compensated for services provided and many patients are left paying out-of-pocket, forced to submit hand written forms to Medicaid for reimbursement.
The number of claims presented by Medicaid patients & providers for hospital stays, lab tests, testing kits, ventilator services, ICU services and more is unprecedented, resulting in two problems:
• Patient claims related to COVID-19 visits, stays, and testing are being returned to the provider as denied, “patient responsibility”.
• Provider claims related to COVID-19 testing kits, supplies, ventilators, treatment stays, etc. are being denied.