New Claims Format Cause of Processing Delays, Gold Coast Says
Gold Coast Health Plan officials are citing a new claims format as the reason for slow claims processing, the Ventura County Star reports (Kisken, Ventura County Star, 4/7).
Gold Coast Health Plan launched in 2011 as an HMO-style alternative for certain beneficiaries of Medi-Cal, California's Medicaid program. The plan administers Medi-Cal to more than 100,000 Ventura County residents who are low-income or who have disabilities.
Recently, the California Department of Health Care Services requested an audit of the managed-care plan after receiving complaints about late payments and poor management (California Healthline, 4/3).
Delays in Claims Processing
Ken Dixon -- account executive for ACS, which contracts with Gold Coast to process claims -- said some claims processing delays were caused by a federal mandate requiring that electronic claims be submitted on a new format called 5010.
According to the Star, health care providers were asked to start using the new format on Jan. 1, but the federal government will not enforce the shift until July.
Dixon told the Ventura County Medi-Cal Managed Care Commission last week that only 23 of the 57 billing groups representing health care providers in Ventura County have fully transitioned to the new 5010 format.
ACS officials said problems occur when companies submit claims configured for 5010 before completing their testing of the format.
Adam Blodgett -- regional vice president for ACS -- said certain claims were "rejected even before they made it to us."
Correcting the Problem
Dixon said formatting problems have been fixed and claims that are months late now are being processed.According to the Star, Gold Coast and ACS officials are reaching out to billing companies to try to resolve remaining payment complaints (Ventura County Star, 4/7). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.