Because I serve on the Health and Human Services Committee, monitoring the status of Heritage Health is an important part of my job as a Nebraska State Senator. Heritage Health oversees the physical healthcare, behavioral healthcare, and pharmacy programs for Nebraska’s Medicaid and Children’s Health Insurance Program (CHIP) clients. Heritage Health contracts with three Managed Care Organizations, namely Nebraska Total Care, United Healthcare, and Wellcare.

Recently, the members of the Health and Human Services Committee met with the management of these three Managed Care Organizations. Today, I would like to report on the progress these three Managed Care Organizations have made in the last few months in order to better serve the people of Nebraska and especially the constituents of Legislative District 47.

By far, the biggest complaint we’ve received in the Legislature has been that claims have not been getting processed, adjudicated and/or paid in a timely manner. Last February, for example, the percentage of clean claims getting processed, adjudicated and/or paid within 15 days was approximately 70 percent of the time. This led to the creation of Corrective Action Plans for our Managed Care Organizations. Today, however, I can report that clean claims are now being processed, adjudicated and/or paid within 15 days of receipt at least 98 percent of the time. Our goal is to get to 100 percent of the time.

Non-clean claims may still take longer than 15 days. We are working on getting all non-clean claims processed, adjudicated and/or paid within 15 days as well. Generally speaking, non-clean claims occur when errors or handwriting appears on a claim form, there is an omission of information, when further documentation is needed, when issues of medical necessity arise, or when claims are filed outside of the filing deadlines.

One issue that has come to my attention from the constituents of Legislative District 47 is out of state care. For some constituents, driving to Lincoln or to Omaha is too far and presents too much of a burden to bear. However, I can now report that by the end of September all three Managed Care Organizations will have contracts with providers in Colorado. This development will bring some much needed relief to those who have difficulty driving long distances. Please check with your Managed Care Organization and get prior approval before you schedule an appointment at a medical clinic or a hospital in Colorado.

Much is being done to improve preventative care for pregnant women. The State saves money whenever pregnancies and birthing processes go well. We can avoid many problems down the road simply by taking proper care of pregnant women. Whether the issue is taking prenatal vitamins, getting an ultrasound, or keeping doctor’s visits, Heritage Health is doing more to provide for healthy pregnancies.

Finally, if you find that you are still having difficulty getting your claims processed, adjudicated and/or paid after 15 business days of receipt, please feel free to call my office at: (402) 471-2616. We will work with you to get your claim(s) paid.