Lawmakers seek Medicaid payment help

Published 6:00 am Tuesday, January 13, 2009

State legislators are considering contracting with anindependent insurance management company to investigate Medicaidabuses and, hopefully, trim costs from the financially embattledagency, a local legislator said.

District 39 Sen. Cindy Hyde-Smith said Senate and Medicaidofficials are looking for a company that can detect and help refundMedicaid overpayments and check for dual enrollees – clients whoseother forms of insurance should pay for services before the statefunds a Medicaid claim.

“We pay so many claims, and we never check to see if there’sother insurance companies involved,” she said. “I don’t know why wehaven’t been doing this for years, but there hasn’t been agatekeeper.”

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Hyde-Smith, D-Brookhaven, said stopping payments to dualenrollees whose private insurance should be responsible forcoverage would save money for the shortfall-affected program, whichlast year ran $90 million short on funding. The budget hole wasplugged by last-minute federal money, and faces a similar shortfallin 2009.

“I want to ensure we have a very good gatekeeper that candistinguish claims we need to make and those that get us on the payand chase mode, where we make the payment and have to chase downthe claim to verify it,” Hyde-Smith said. “It would be the laststop before the check goes out the door.”

As per state hiring practices, state leaders will screen severalcompanies before making a decision. So far, Senate and Medicaidofficials have researched the idea by meeting with representativesfrom Tennessee-based AIM Healthcare Services, Inc.

AIM Healthcare Services, Inc. Vice President Brad Hill said hewould be on hand in Jackson beginning Wednesday for three days toexplain what his and similar companies can provide for Mississippilawmakers.

Hill said companies like AIM use extensive databases ofcooperative insurance providers that can be checked for dualenrollment.

“We’d act as an intermediary to see if we can find any instancesof overlapping coverage,” he said. “Medicaid is the payer of lastresort in most instances, and we would work with commercialcarriers in Mississippi to see if eligibility existed on theirrecords that would cause them to the primary payer for servicesinstead of Medicaid.”