Georgia Payment Problems Ongoing

Atlanta

Soon after Dallas-based Affiliated Computer Systems (ACS) took over HIPAA-compliant electronic processing of Georgia Medicaid claims last year, massive payment processing difficulties ensued — and today the problem still isn’t resolved, according to the Georgia Association of Medical Equipment Services (GAMES).

Since last April, Medicaid reimbursements have followed a complicated prospective payment system, said Jason Rogers, GAMES president and vice president of Athens, Ga.-based Care Medical. ACS paid providers a weekly amount based on an average of payments they received during the 12 weeks before April 1, 2003.

Earlier this year, the state “stopped paying the prospective payments despite [the fact that current] claim payments were not up [to] previous levels,” Rogers said. He said the state is now withholding half the amount of each claim payment to recoup prospective payments it has sent to providers.

“It is a tough situation for providers,” Rogers said, adding that ACS has said it will soon start a “mass of readjustments” going back week by week to reprocess claims that were improperly denied or still pending.

“It’s just [that] we’re a year down the road,” Rogers explained, “and I don’t know how [the state will] work through the backlog at this point.”

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