Medicaid has regulations on how long providers have to submit claims for reimbursement, this is called timely filling. For claims originally submitted in a timely manner but denied payment, the DVHA Reimbursement Unit will review for payment. This performance measure will track how long the Reimbursement Unit takes to review denied claims and make a final decision on whether or not to pay them.
This measure is important to ensure that provider reviews of timely filings are processed in a consistent and timely manner. Providers will appreciate having a decision sooner rather than later.
The August 2019 target was not met due to a competing project that was prioritized for the individual devoted to working timely filing requests.
An important factor in meeting the unit’s target each month is consistency in the flow of and volume of requests received. During the period of June to December 2019, the volume of requests increased an average of 146% compared to the same period of 2018. The per month increases ranged from a low of 10% to a high of 394%. The increase in volume can reasonably be attributed to the issuance of updated timely filing guidelines in February 2019. It had been many years since the last update.
In addition to an increase in volume, or perhaps because of it, DXC informed the unit in October 2019 that they were experiencing a delay in forwarding requests. Over the next 3 weeks DXC uploaded the backlog of requests in large batches while continuing to upload the ongoing requests being received. As a result, the unit has been unable to meet its monthly target of completing 80% of requests received in 15 business days. The unit is continuing to diligently work through the backlog in addition to the ongoing normal flow of requests being received. We anticipated it will take many months to get caught up.
By March of 2020 the backlog was completed along with the normal monthly flow of requests resulting in the unit meeting its target goal.
Last updated: 10/15/2020