Medicaid contractor stops trying to recoup payments from mental health providers

Mental health therapists in Colorado will no longer have to repay money they received to see Medicaid patients after a government contractor threatened to “compensate” the payments on Wednesday.

Mental health counselors at clinics in eight Front Range counties have received emails from the Colorado Community Health Alliance — the contractor that processes their Medicaid claims — notifying them that it is “discontinuing its current payback project.” This comes after the Health Alliance sent out letters asking therapists to return thousands of dollars in payments they had already received, a financial disaster that has been attributed to a software error.

This week’s reversal by the government contractor came after reports in The Colorado Sun and 9News revealing that the claims failed. Several mental health counselors and therapists working in small group practices told The Sun they would no longer accept Medicaid patients because of the headache of paperwork and a recent battle with the government contractor.

For some, the reversal is too little, too late.

Carla D’Agostino Vigil, one of the only OCD specialists to accept Medicaid in Colorado, was among those who decided she would no longer see Medicaid patients due to recent trouble. While she welcomed the Health Alliance’s announcement, D’Agostino-Vigil said Wednesday that it has no plans to change its mind about accepting Medicaid clients.

“I am cautiously optimistic that this will lead to a correction in time,” said D’Agostino-Vigil, who operates Ignite Counselling in Westminster.

The licensed counselor was already experiencing a 20% reduction in Medicaid patients instituted by the Health Alliance in January 2020. D’Agostino-Vigil is still in the midst of an unrelated dispute with the Health Alliance over claims it was denied due to an issue with the Alliance’s program.

The coalition said therapists who have already paid a refund fee to Health Alliance will get a refund.

Refund letters, copies of which The Sun reviewed, told providers they had 60 days to return the money or the Colorado Community Health Alliance could withhold future payments. Health Alliance, owned by insurance giant Anthem, is essentially the intermediary between providers and the state’s Medicaid administration and is responsible for processing claims and disbursing payments.

Therapists were not overpaid – they were required to return money for services they had provided in previous years because claims were missing a provider identification number.

Mental health professionals said they included the provider identification number in their claims. It was the computer system used by the Health Alliance that omitted the identification numbers – which are required by state and federal law – from its claims. Spokeswoman Colin DeWalt said the contractor realized the error in July 2019 and fixed its software in October 2020. Mental health providers have been warned about the issue via email and in meetings since March 2020, but many said they were surprised when they received refund notices asking for payment this fall .

The Colorado Community Health Alliance is the driver for 1,175 behavioral health service providers in Boulder, Broomfield, Clear Creek, El Paso, Gilpin, Jefferson, Park and Teller counties. About 200 providers who did not resubmit claims received letters of refund, which requested amounts of up to $18,000.

The Health Alliance said Wednesday that it would retract the compensation measure “in light of recent comments from behavioral health practices.”

Rather than requiring therapists to pay or resubmit claims, the Health Alliance is making plans to call each consulting practice to retrieve the requested provider identification numbers, Daywalt said in an email to The Sun. “We plan to work with service providers to collect data to ensure we have the appropriate documentation without requiring providers to resubmit claims,” ​​she said.

She said the coalition is “dedicated to ensuring access” to mental health care in Colorado, noting that there are now 3,514 practitioners in the network.

The billing issue comes as Colorado has tried to increase the number of mental health professionals that accept Medicaid, a state insurance program for low-income residents and the disabled. The Colorado Department of Health Care Policy and Finance, which administers Medicaid and contracts with the Health Alliance to distribute payments to providers, said the number of health care providers statewide receiving Medicaid reached 8,371 in June, compared to 6,029 in April 2020.

On Wednesday, the department said it was pleased with the state and contractor “selecting an easier method” to collect the required claim information. Department spokesman Mark Williams said in an email to The Sun.

“While 84% of providers were able to comply with a claim data request within a period of more than 20 months from the time submitted, we understand that this issue represents a heavier administrative burden for the rest of the providers.”

Williams added that the decision “enables all of our behavioral health providers to continue providing care to Medicaid members—particularly during this time of increased demand for these services due to the effects of COVID-19.”

Christia Young, a therapist in Brighton who received a notice of a $7,200 refund, was skeptical that the announcement meant things with the alliance would improve.

“It’s good news, but I’ve already paid my attorney, drafted a letter, and spent a good portion of my time faxing all of the corrected allegations,” said Young, who sees patients with chronic suicidal thoughts on Badass Therapy. “It also doesn’t fix all the other issues that providers have with them. I already had many billing issues before that.”

Young stopped taking Medicaid patients through the Health Alliance.

“My Medicaid clients are one of my favorites to work with,” she said. “It was heartbreaking to have to prioritize my mental health and financial well-being because it is so difficult to work with Medicaid.”

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