Georgia Reports Computer Problems With Medicaid Payments

Atlanta

Since April 2003, Georgia providers have been filing electronic Medicaid claims based on ANSI standard HIPAA-compliant software. Unfortunately, receiving payment for such claims has been anything but smooth, according to Mike Hamilton, executive director of the Georgia Association of Medical Equipment Services (GAMES).

Last month, Phoenix-based consultants FourThought Group reported to the state’s Department of Community Health, which administers Georgia’s Medicaid program, that not all claims were paid correctly and payments were not sent to the correct providers. The state has a contract with Dallas-based Affiliated Computer Services to process Medicaid claims.

If a percentage of unpaid claims on-hand is significantly higher than paid claims for a given week for a particular provider, state claims processors have sent that provider payments equal to those received at the same time during the previous year, Hamilton said. “It gives you some cash,” he added, “but you don’t know where to apply it. It’s an accounting nightmare. For a new or rapidly growing company, those interim payments are going to be far short.”

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