HealthFirst and Prompt Payment

June 15, 2023

The NYS Council, along with assistance from our Billing Geeks, has been advocating on behalf of our members who recently received a letter from HealthFirst informing them that the MCO had made an error when calculating the Prompt Payment interest it owes many providers for having failed to pay recently enacted rate increases on time and in full.  Recently the MCO sent letters to impacted providers stating the provider has 60 days to pay back the allegedly miscalculated interest in full or face automatic recoupment from future reimbursement.  

The NYS Council has always been assertive in our advocacy regarding these types of problems, and this situation is no exception.  We took this issue to OMH and pressed for action. OMH has been responsive.  This week impacted providers began receiving letters from HealthFirst stating that the recoupment is ‘on pause’ while the state reviews the matter with the MCO.  In the end it may be that HealthFirst has the right to recoup the interest it says it mistakenly overpaid providers. On the other hand, it may be that HealthFirst used the wrong date from which to calculate interest due to providers and as such the MCO owes the provider more interest.  We will know more shortly.  

The magnitude of the problems associated with MCOs failing to follow timely payment and other laws and regulations cannot be understated. From what we can see, HealthFirst failed to pay the correct rates for many months after they were given the required notice of rate changes.  As such, the re-adjudication process for the thousands and thousands of claims submitted by providers during that time continues to be a nightmare for impacted agencies.  Providers receiving a letter saying the provider owes the company money for a mistake it made just adds insult to injury.  

This is the work the NYS Council performs every day on behalf of our members, and it is just one more example of the absolute chaos that results from the state carving behavioral health services into Medicaid managed care.  Having to employ an army of staff to chase payments and try to detect and address the many ways some MCOs capitalize on the carve-in of our services and in doing so, reduce access to care, is why we fight for wholesale reform, and specifically, for our services to be carved out of MMC. 

The NYS Council deeply values the work you do each day.  We will continue to fight for your rights.