Lawrence Memorial Hospital's Susan Thomas tells Kansas lawmakers about the hospital's difficulty in filing claims and getting paid by KanCare, the state's privatized Medicaid system.

Topeka ? Lawrence Memorial Hospital officials on Friday provided a detailed list of examples of cases in which private companies now managing the state’s Medicaid system have wrongly denied claims or tied up payments in lengthy appeals processes.

“They’re not situations of incorrect filing,” said Susan Thomas, director of compliance management at LMH. “They’re correctly submitted claims that just get caught up in the (Managed Care Organization) processing system.”

Thomas and other LMH officials spoke Friday before the joint KanCare Oversight Committee, following up on their testimony in early December when they alleged the three private contractors that now manage the program had been systematically denying valid claims in order to hold down costs.

Committee members said at that time that LMH should come back to the next meeting with documentation and examples of that practice.

Lawrence Memorial Hospital's Susan Thomas tells Kansas lawmakers about the hospital's difficulty in filing claims and getting paid by KanCare, the state's privatized Medicaid system.

Gov. Sam Brownback’s administration privatized the Medicaid system, now known as KanCare, in 2013. Now, private companies, known as Managed Care Organizations, or MCOs, are in charge of processing claims, making payments and coordinating the care of patients, particularly the elderly and disabled, the two most expensive population groups to cover.

Thomas cited one example of a patient who received an MRI exam for a knee injury in September 2014 after the hospital had received authorization to perform the procedure. But Sunflower State Health Plan, the company that manages that patient’s plan, denied the claim, saying at first that it hadn’t been authorized.

A few days later, Sunflower notified LMH that it had found the authorization and would process the claim, but then in December the claim was denied again for lack of authorization.

After numerous phone calls and meetings, the claim was eventually resolved in January 2015, after 468 days, when Sunflower finally paid LMH the $470 bill.

Chris Coffey, CEO of Sunflower, did not respond directly to that case, but said his company sends representatives to meet regularly with major providers like LMH to work through individual billing and payment issues, and he said overall the company has a good record of paying claims on time.

“From what we can tell just generally, from 2013 through the end of last year, it’s really very consistent,” he said. “The total paid amounts were very close year over year. Claims received are all within the same range, a few hundred claims different. Denial percentages in the ballpark of 13 to 10.5 percent year over year.”

He also said that the average time it takes Sunflower to pay a claim is about six and a half days from the time it’s received.

Thomas also cited examples of cases involving each of the other contractors, Amerigroup and United Healthcare.

Some of the cases involved newborns, which she said is a common problem because it takes several days, or even weeks, to receive a permanent identification for a newborn, even if the mother already has one.

In another case, she said, Amerigroup initially paid only the physician fee, but not the emergency room fee, when a Medicaid-enrolled toddler came to LMH with a foreign object stuck in his nose.

Officials from all three companies said that they have been working closely with LMH since the allegations were first lodged in December and that they are working hard to resolve those issues.

But like Coffey, they said that overall, Amerigroup and United Healthcare have a good record of approving most claims and paying them promptly. And they rejected LMH’s suggestion that there were widespread or systemic problems affecting providers throughout the state.

Rep. Jim Ward, D-Wichita, said he believes the problems are more widespread.

“I have no doubt in my mind that we could fill this room up with providers that would describe the same kinds of problems with these three MCOs,” he said.

But Sen. Jim Denning, R-Overland Park, who works as a health care administrator, said the problems are not unique to Medicaid.

“You’ve just described the daily life of anybody that works in a health care practice or a hospital,” he said. “All of these issues, just pick an insurance company — Medicare or any commercial (company). I could bring a hundred of these examples tomorrow. It’s not unique to Medicaid; it’s across the spectrum.”

The committee took no formal action regarding LMH’s complaints, but encouraged the hospital and the three companies to continue working to resolve the issues.