Chaney pushes NMHS, United Healthcare to meet

Northeast Mississippi Daily Journal (Tupelo)

Oct. 28--TUPELO -- After hearing from both North Mississippi Health Services and United Healthcare, Insurance Commissioner Mike Chaney wants to bring the sides together.

"As a result of our analysis of the Oct. 21 status reports provided by UHC and NMHS, the department is in the process of scheduling a meeting with the parties in an effort to facilitate an amicable resolution," Chaney said in a statement late Wednesday.

At the end of September, Tupelo-based North Mississippi Health Services announced it would terminate its provider agreement with United Healthcare for 2017 because it had not been able to resolve issues over inaccurate payments discovered in April.

Because of the potential effect on customers, the Department of Insurance became involved with the dispute early this month.

"Should this meeting fail to yield substantial results, the department is prepared to take regulatory action," Chaney said.

Regulatory actions could include payment adjustments, fines and other penalties.

Leaders with both United Healthcare and North Mississippi Health Services said they want to see the issue resolved.

"We will continue to update the Department of Insurance on the significant progress we are making on the claims payments to NMHS," said Elizabeth Calzadilla-Fiallo, public relations director for Florida and the Gulf States Region for United Healthcare. "We expect the health system will honor its contract with United Healthcare and continue serving our members' health care needs as we work toward a resolution."

Officials with North Mississippi Health Services were unavailable for comment Thursday.

In the spring, NMHS found electronic reimbursements were coming in from United Healthcare, marked as paid, but for $0. In mid-October, the health system shared its research with the company.

United Healthcare leaders said the company's internal investigation has not found the same problems.

"An initial sampling of the claims North Mississippi Health System provided has shown many were in fact paid correctly," Calzadilla-Fiallo said in a statement.

If the termination goes into effect, North Mississippi Medical Center-Tupelo would go out of network for United Healthcare customers on Jan. 1. NMMC community hospitals in Pontotoc, Iuka, Eupora, West Point and Hamilton, Alabama would go out of network May 22. North Mississippi Medical Clinics would be affected on Aug. 14.

The out of network status would affect people with United Healthcare policies purchased individually or through their employers, Medicare Advantage policies through the insurer and Mississippi Medicaid CAN participants who used United Healthcare's coordinated care network. About 7 percent of North Mississippi Health Services patients are covered by United Healthcare.

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