On Saturday, The Seattle Times ran a a front-page story detailing the many failures of Washington's new computer system for processing Medicaid payments. The article claimed the system, known as ProviderOne, is "plagued with glitches," over-budget, and poorly planned. It also alleged the system couldn't keep up with billings and had forced some cash-strapped medical providers to stop treating the sick for fear they won't be reimbursed.
Times reporter Sean Collins Walsh wrote that ProviderOne has "suspended" -- that is, left unprocessed -- "about 58,000 claims per week since the beginning of September." That's roughly 15 percent of the 800,000 claims sent in every week
But according to Heidi Robbins Brown, DSHS's Deputy State Medicaid Director, that's exactly what's supposed to be happening. The system is designed, she says, to put a hold on larger, more complex claims so they can be looked over by hand. "[Walsh] didn't point out that most of those claims got accepted or denied a day or two later," she says.
Had Walsh actually run the numbers correctly, says Robbins, he would have found that ProviderOne is significantly delaying the processing of only about one percent of total Medicaid claims, not the 15 percent that would suggest a system "plagued with glitches." She also points out that context would have punctured Walsh's other scary figure, a backlog of 271,000 claims, because DSHS has handled more than 22 million since ProviderOne went live in May.
As for being over budget, Robbins says that's also not true. In the five years since the contract was signed, the budget has gone up, but at no time did the cost exceed the budget, she says. And the angry providers? The numbers suggest they're part of an extremely small minority.
Of the four providers quoted by Walsh, one, Wellspring Family Services, has only billed 10 claims. "And they've all been denied for a good reason," says Robbins.
Robbins says that in this case, the squeaky wheels are smaller, more rural providers who failed to take advantage of DSHS's six-month training period to help introduce ProviderOne to the people who would be relying on it. "The big providers tested," she says. "The rest of them are learning through trial in error, and most of them are doing a good job."
But unfortunately for Robbins and her department, which, like most state agencies, has seen big rounds of layoffs this year, the article couldn't have come at a worse time. "When budgets are tight a headline that suggests we're mishandling our money is very much a concern for us," she says.
We were unable to reach Walsh at the phone number listed with his story. Two members of the newsroom who answered the call said Walsh's last day was Friday. Robbins says that when a DSHS spokesperson contacted the Times yesterday in an attempt to have a correction printed, he was told by an editor that Walsh wasn't a reporter, but an intern. Meanwhile, our own calls to Walsh's editor thus far haven't been returned