Newsroom > DHHS News Release
For Immediate Release
October 19, 2017
Julie Naughton, Public Information Officer, Communications and Legislative Services, (office) 402-471-1695 or (cell) 402-405-7202, firstname.lastname@example.org
Medicaid Heritage Health Plans Continue Positive Trends
LINCOLN— Heritage Health, Nebraska Medicaid’s managed care delivery system, continues on a positive trend, serving over 230,000 of Nebraska’s most vulnerable citizens, according to Thomas “Rocky” Thompson, interim director of the Division of Medicaid and Long-Term Care.
Performance results are public and can be found in the Heritage Health dashboard report at http://dhhs.ne.gov/medicaid/Pages/HeritageHealthPlans.aspx, which includes data about enrollment, claims and claim timeliness, grievances and appeals, and response times.
Highlights from August include:
Timeliness in Processing Clean Claims Payments to Providers
In August, Nebraska Total Care paid 97.3 percent of clean claims - a clean claim is one that is complete when submitted, without complications or errors that might cause a delay in payment, and a claim may have been denied and resubmitted as a clean claim - within 15 days. UnitedHealthcare paid 97 percent and WellCare paid 95.1 percent in the same time period. All three managed care organizations (MCOs) are above the target, which is 90 percent.
The three plans have paid providers more than $404.2 million since the inception of Heritage Health in January.
In August, Nebraska Total Care paid 134,711 provider claims, while UnitedHealthcare paid 104,692 claims and WellCare paid 80,097 claims in the same time period.
All three plans maintain known issues logs on their websites that include the resolution dates or expected resolution dates for all identified issues. All relevant links are below.
Enrollment in each of the managed care organizations’ plans remained stable, with UnitedHealthcare at 75,149, Nebraska Total Care at 75,875 and WellCare at 76,498.
Open enrollment for the 2018 Heritage Health plan year begins on Nov.1 and concludes on Dec.15. Those enrolled who wish to stay with their 2017 plan will be automatically re-enrolled.
Over 530 members have reached out in advance of the start of open enrollment to report they are happy with their current plans and do not want to change to a different plan.
Average hold time for providers in August was 47 seconds for Nebraska Total Care, 35 seconds for UnitedHealthcare and 24 seconds for WellCare.
Call abandonment for providers in August was 0.2 percent for UnitedHealthcare, 0.8 percent for Nebraska Total Care, and 1.6 percent for WellCare.
Average answer speed for providers in August was 24 seconds for WellCare, 13 seconds for Nebraska Total Care, and 8 seconds for UnitedHealthcare.
Members continue to share success stories. A restricted service member (one who has been cited for inappropriate and/or excessive use of Medicaid services) was referred to the health plan’s care management service for assistance in finding and establishing a new primary care provider. This member was having a very hard time finding one because she was on restricted service and she had been dismissed from her most recent provider for the same behaviors that had resulted in her restrictions to begin with.
For nearly three months, the Heritage Health care manager worked with the member to find a new doctor. The member did not want to call provider offices and tell them that she was on restricted services. The care manager assisted the member, and they found a provider who would accept her. Once the provider’s acceptance was confirmed, the care manager met the member in person to obtain the member’s signature and additional information. Thanks to the commitment of the health plan’s care coordinator to the member and with prospective providers, this member once again has a medical home where her health needs can be met.