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Nebraska now has a year and a half of experience with Heritage Health, its revamped approach to serving the state’s nearly 230,000 adults and children eligible for Medicaid.

The system provides considerable improvements over the state’s previous approach. But as legislative hearings have shown, Heritage Health needs regular monitoring to address the challenges in managing $1.2 billion worth of annual claims.

Under Heritage Health, providers address an individual’s care and treatment in a comprehensive way, no longer separating the attention to a client’s physical health and mental health issues. Heritage Health has strengthened services such as education for new and expectant mothers; health checks for children; and coordination of behavioral, physical and pharmacy services. These are welcome improvements.

Under the program, three private companies manage and pay for the bulk of Medicaid services.

Testimony before Nebraska state lawmakers has identified various challenges to be addressed: adequate reimbursement to providers; consistent application of rules; correct processing of claims; and adequate staff training.

At a recent legislative hearing, State Medicaid Director Matthew Van Patton said the three Heritage Health management companies had processed at least 97 percent of “clean claims” — those without errors or other problems — within 10 days during the first three months of 2018.

An outside reviewer had found each of the three companies in compliance with seven quality measures, he said.

However, Melanie Standifer, revenue manager for CenterPointe treatment center in Lincoln, told lawmakers that about 70 percent of the claims denied by the managed care companies are denied incorrectly. “There is an unacceptable amount of administrative burden on providers,” she said.

Leisha Eiten, representing the Nebraska Speech Language Hearing Association, said many audiologists have stopped taking Medicaid patients because of claims payment problems with Heritage Health.

Heritage Health deserves praise for the positives it achieves in managing an enormously complex part of Nebraska’s health care system. At the same time, the concerns raised by providers need to be addressed. Management or staffing problems mustn’t get in the way of making sure that vulnerable Nebraskans receive the services they need.

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(1) comment

GEORGE BRODSTON

When this many health care providers are refusing to take Medicaid patients because of reimbursement refusals and other hassles, this can hardly jive with the rosy, congratulatory tone of this editorial. When you give a private company a lump sum of money and tell them to take care of people with it and keep the difference....guess what.

Welcome to the discussion.

Please keep it clean, turn off CAPS LOCK and don't threaten anyone. Be truthful, nice and proactive. And share with us - we love to hear eyewitness accounts.

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