Newsroom > DHHS News Release

For Immediate Release
November 29, 2017

CONTACT
Julie Naughton, Public Information Officer, Communications and Legislative Services, (office) 402-471-1695 or (cell) 402-405-7202, julie.naughton@nebraska.gov  
 
Medicaid Heritage Health Highlights Timely Payments, Enrollment

 

LINCOLN— Heritage Health, Nebraska Medicaid’s managed care delivery system, continues successfully serving more than 230,000 of Nebraska’s most vulnerable citizens, according to Thomas “Rocky” Thompson, interim director of the Division of Medicaid and Long-Term Care in the Department of Health and Human Services.

Thompson shared recent data with Nebraska state senators and also highlighted Heritage Health’s open enrollment period that runs from Nov. 1 to Dec. 15. 

Heritage Health performance results are public and can be found in the Heritage Health dashboard report at http://dhhs.ne.gov/medicaid/Pages/HeritageHealthPlans.aspx. It includes information about enrollment, claims and claim timeliness, grievances and appeals, and response times.

Highlights include:

Enrollment:

  • Enrollment in each of the managed care organizations’ plans remained stable, with UnitedHealthcare at 77,072, Nebraska Total Care at 76,430 and WellCare at 75,506.
  • Open enrollment for the 2018 Heritage Health plan year began on Nov.1 and concludes on Dec.15. Those enrolled who wish to stay with their 2017 plan will be automatically re-enrolled.
  • A comparison of the plans, including a list of value-added services, is available at https://www.neheritagehealth.com/healthplan/search

Clean Claims Received

  • In September, 97.1 percent of provider claims to Nebraska Total Care were clean claims. In the same time frame, 81.7 percent of claims submitted to UnitedHealthcare and 80.2 percent of claims submitted to WellCare were clean.
  • A clean claim is one that is complete when submitted, without complications or errors that might cause a delay in payment. A claim may have been denied and resubmitted as a clean claim.

Clean Claims Processed
Timeliness in Processing Payments to Providers

Provider Calls:

  • Call abandonment for providers in September was 0.4 percent for UnitedHealthcare, 0.8 percent for Nebraska Total Care, and 2.3 percent for WellCare.
  • Average answer speed for providers in September was 45 seconds for WellCare, 15 seconds for Nebraska Total Care, and 8 seconds for UnitedHealthcare.

Members continue to share stories of how Heritage Health is helping them live better lives. For instance, building relationships with plan members and helping them live better lives is what Heritage Health case managers do.  Sometimes that relationship becomes the most important one in that plan member’s life. 

For example, “Brittany,” a Heritage Health plan case manager, developed a strong relationship with “Alma,” an elderly member with complex health conditions.  Brittany and Alma talked frequently about Alma’s physical and behavioral health needs.  One day, without warning, Alma’s phone was disconnected.  Having real concerns for her friend’s safety and well-being, Brittany asked one of the plan’s member connections staff to check on Alma.  The staff member found Alma to be disoriented and confused.  She was able to quickly assess the situation and followed up immediately with Brittany.  Fortunately, Alma had a doctor’s appointment later that day.  Brittany contacted the doctor’s office and spoke with the nurse about her concerns and the assessment.  The doctor’s office reported back after the appointment and thanked Brittany for alerting them so they were better prepared to talk with Alma about her needs.  Brittany was relieved that Alma agreed to move to an assisted living facility, meaning she would be safe and her physical and behavioral needs could be better met.  We will never know if harm would have come to Alma without this intervention, but we do know that Brittany’s care and concern made a positive difference in Alma’s life.

More member stories can be found at http://dhhs.ne.gov/medicaid/Pages/HHSuccessStories.aspx.

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