Iowa on track to save $22 million in Medicaid spending
That and other details were included in the
The report, released Friday, help shed light on what the first three months of
The state is projecting the move to managed care saved it more than
The
Highlights from the quarterly report include:
Grievances and appeals
A grievance is a written or verbal expression of dissatisfaction, while an appeal is a request for review of an MCO's denial, reduction, termination or delay of services. While all three MCOs resolved beneficiary grievances within 30 days of receipt, according to the report, one MCO, Amerigroup, received far more complaints than the other two.
Grievances:
--Amerigroup received 145 grievances during the quarter
--
--UnitedHealthcare received 39.
Appeals:
--Amerigroup received 14 appeals during the quarter
--
--UnitedHealthcare received 49.
Finances
Capitation rates -- or the per member, per month fees paid to the MCOs by the state -- equal more than
--Amerigroup --
--
--UnitedHealthcare --
Claims
Providers across the state have reported late and inaccurate payments to state lawmakers and news outlets since the
All three MCOs met the requirement of paying or denying 90 percent of "clean" claims -- properly completed claims -- within 14 days, according to the report.
But a more detailed look at the data shows:
--UnitedHealthcare had the highest number of denied or suspended medical claims, according to the data. In April, it only paid 49 percent of claims, while the other 51 percent were either suspended or denied.
A suspended claim means it is pending internal review for medical necessity or needs additional information. By June, UnitedHealthcare's paid claims increased to 67 percent, with the remaining 33 percent either denied or suspended.
--
--Amerigroup paid between 95 percent and 88 percent of claims in the first three months, the report shows. It had no suspended claims.
Varying Reimbursements
The dollar amount spent reimbursing providers varies widely among MCOs. The state pointed out that population difference between plans can be a factor in the levels of reimbursements.
--Amerigroup paid hospitals
--Amerigroup paid physicians
--Amerigoup paid
Enrollment
The vast majority of
That's compared to 10 percent (18,729) of Amerigroup's more than 184,000 enrollees, and 11 percent (18,684) of UnitedHealthcare's more than 175,000 enrollees.
Special needs populations
That's compared with 1,315 special-needs adults 490 children enrolled in Amerigroup, and 962 special-needs adults and 467 children enrolled in UnitedHealthcare.
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