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Insurance claims clearinghouse worries new Medicaid system not ready

An insurance claims clearinghouse that works with North Carolina healthcare providers is worried about the state's new Medicaid payment system.

As first reported in the Triangle Business Journal, an executive with Florida-based Availity wrote a letter to state Department of Health and Human Services Services Secretary Aldona Wos saying the company has not been given "numerous operational details" about the system.

Providers file insurance claims with Availiity, which then submits them for processing. The letter's author, Availity senior vice president of provider solutions Scott Herbst, declined through a company spokeswoman to be interviewed.

The state Department of Health and Human Services will switch to the new system July 1.

DHHS spokesman Ricky Diaz said Computer Sciences Corp, the company that built and will operate the system, has set up a special technical support group for companies such as Availity.

DHHS and CSC are readying a 'war room' for July 1, where problems with payments can be handled quickly, Diaz said.

"We've been pretty up front with the fact that we expect some bumps in the road," based on other states' experiences with switching to a new bill processing system, he said.

The department announced earlier this month that it had completed final tests of the system, and that more than 1.2 million claims were paid successfully.


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