- Associated Press - Monday, August 25, 2014

BOISE, Idaho (AP) — The state’s effort to rein in Medicaid costs has created deep friction between small businesses that deliver behavioral-health services to Medicaid patients and a new contractor hired to manage them.

Service providers across Idaho have raised complaints over the last 11 months that the contractor, Optum Idaho, a unit of United Behavioral Health, has created red tape and cut services needed by at-risk patients.

Now providers in the Treasure Valley have raised another complaint: Optum isn’t paying them promptly, putting their businesses’ survival and employees’ jobs at risk.

Optum says it has fixed a glitch that resulted in tiny claims payments to the companies, which provide counseling and other behavioral health services to low-income and disabled adults and children on Medicaid.

Optum says it erroneously sent small checks totaling amounts like $.05, $.07, or $.11 starting Aug. 1 to providers who care for Medicaid patients who need behavioral-health treatment.

“(We) apologize for any inconvenience caused by this temporary error, and we invite any provider with concerns or questions to call Optum Idaho,” Optum said in a statement.

But some providers say the problem actually began last September, when Optum took over management of Idaho’s Medicaid behavioral health system.

Two of the Treasure Valley’s largest mental health care providers for Medicaid patients say these tiny payments have recurred throughout Optum’s first 11 months in Idaho.


Idaho spends $10.5 million a month on average for outpatient behavioral health, mental health and substance-abuse programs for adults and children on Medicaid. Optum can keep up to 15 percent of that for administration, the state says. Lawmakers approved the managed-care system in 2013 as a way to control costs and boost efficiency.

“We had one situation not long after Optum came on board where they paid a wide range of codes at one penny per claim when the claims were as much as $200 or $300,” said Tami Jones, the CEO of Idaho Behavioral Health in Boise. Each mental health service or procedure has a code number.

“Every single service we’ve provided, we’ve had at one time or another a situation like this, where they’ve paid the wrong amount, and it’s always been a much smaller amount like 11 cents on a $100 claim,” Jones said.

Remittance documents from Optum’s parent, United Behavioral Health, to Boise’s Access Behavioral Health, show payment errors dating to October.

“They’ve told providers they don’t know why it’s happening, and when it’s going to be fixed, and they have no idea when we’ll start seeing checks paid at the regular amount,” said Access owner Nikki George.


Story Continues →