Maryland Owes Millions of Dollars to Mental, Behavioral Health Providers

February 2020 ~

Mental and behavioral health providers in Maryland are owed millions of dollars for services that have gone unpaid because of a malfunctioning state payment system.

The Maryland Health Department, which oversees the payments, in January, issued a letter to state public behavioral health system providers explaining the error –which occurred during the transition from Beacon HealthOptions to Optum- and their commitment to re-pay physicians for services rendered.

The agency is now sending out estimated payments (based on your average weekly payments in 2019) to providers totaling at about $32 million a week as it works to fix the system.

According to the letter, this payment change will affect all Optum Maryland registered providers. The Maryland Health Department states it will continue these estimated payments until April 20, 2020 or until the Optum system is acceptable to Governor Hogan’s customer service promise.

All providers must continue to submit authorization requests and claims for services rendered. Optum will reconcile claims against estimated payments made. Over/under payments will be addressed every 60 days. The agency will audit Optum activities as well as claims submitted for program integrity. Additional information will be provided as it is developed.

“We have been working on this for a few months,” said the state’s Medicaid director, Dennis Schrader, “In a perfect world, these transitions would be flawless, but in reality you sometimes run into transitional issues. We want to make sure providers are held harmless while we’re fixing the system.”

Maryland’s Medicaid program currently provides services to over a quarter-million people within the state and pays for a disproportionate amount of such treatments compared with other types of health insurance. State figures show that an estimated 260,000 to 280,000 utilize behavioral health services, including treatment for opioid addiction, an epidemic that has claimed thousands of lives in recent years.

The system glitch is estimated to affect approximately 2,500 physicians, hospitals, clinics and other facilities offering mental and behavioral health services throughout the state.

“We have been working on this for a few months,” said Dennis Schrader, the state’s Medicaid director. “In a perfect world, these transitions would be flawless, but in reality you sometimes run into transitional issues. We want to make sure providers are held harmless while we’re fixing the system.”

Source(s): Maryland Health Department Provider Alert; The Baltimore Sun; HMA Weekly Roundup February 5, 2020; WBALtv;