And There Is A New Problem!

September 29, 2022

The original revalidation issue is (maybe) fixed; though I’m not sure we have a final word on that.   That was the one that attached the revalidation to multiple service locations. 

The second major issue was the removal of more than 6,000 providers from the system for “lack of a license.”  That issue, we think has been fixed and the providers have been restored.  It has, I understand, caused more of an issue for providers who bill through an MCO because information was lost in the process.  Fee-for-Service providers should be OK with that issue.

The latest issue is that providers who did revalidate successfully are having claims denied; this problem is truly the left hand does not know what the right hand is doing.  Enrollment says everything is fine; Claims says the provider is not enrolled.  Not only are claims not being paid, but providers are spending hours bouncing back and forth between the two “helplines” and can not resolve the problem themselves!  

We have escalated the issue and will keep you posted.  I would try to say something lighthearted, but there is nothing lighthearted to say.    DMAS needs to fix this and build a “helpline” system that is truly helpful!