Saturday, August 20, 2016

Problem with state employee drug benefit payments

Posted By on Sat, Aug 20, 2016 at 7:47 AM

Late Friday, I received a partial response to an inquiry to the state Finance and Administration Department about reports of failure to properly process drug claims for people covered by the state health insurance program.

I was unable to get answers to followup questions, but for those who raised the issue, the response from Jake Bleed of DF&A suggests the problem has been corrected. Why it happened, how long it had persisted, how many people were affected and whether accounts have been squared with all pharmacies are among the pending questions:

We were made aware that some providers were not receiving authorized payments through our pharmacy benefits manager, MedImpact. DFA – Employee Benefits Division staff immediately contacted MedImpact and confirmed that some valid payments had been held by MedImpact. The issue apparently deals with the system MedImpact uses to differentiate between eligible claims which should be paid and ineligible claims which should not.

MedImpact then reported back to the agency that all held payments had been released as of the about 12 hours after being initially contacted. We have since followed up with MedImpact to determine more about the nature and the extent of the problem and are still in the process of determining how this happened, how many were effected, and what MedImpact will be doing in the future to ensure it never happens again. 
Personal experiences welcome.

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