Up until January 31, 2015 Home Care Path received regular direct deposit payments about every two weeks. This stream lined process flowed through Madison Wisconsin. It was just too good to be true.
As of February 1, 2015 Home Care Path has been required to submit ContinuUs member claims to WPS Insurance Corporation El Paso, Texas. Since February 1, 2015 Home Care Path has not received a payment for the properly submitted claims.
Value of unpaid claims submitted for the period 2/1/15 to 2/15/15 is 8651.00
Value of unpaid claims submitted for the period 2/16/15 to 2/28/15 is 7810.00
Value of unpaid claims submitted for the period 3/1/15 to 3/15/15 is 9373.00
Total value of unpaid claims 25,834.00
The Family Care Contact Center 800-223-6016 can tell us the claims are in process but no more. Provider services have requested the payment be expedited for the benefit of the vulnerable members needing the personal supportive care service Home Care path staff provide.
Home Care Path contracts with ContinuUs the Care Management Organization to deliver authorized personal supportive care services to vulnerable nursing home level of care persons who choose to live at home. This practice is thought to save the State of Wisconsin and the Medicaid program money, by meeting unskilled needs outside of the nursing homes.
ContinuUs contracts with WPS Insurance Corporation who out sources claims processing to El Paso Texas. The risk of moving the claims processing from Madison Wisconsin to El Paso Texas is felt by providers and vulnerable members alike. Home Care Path lacks the monetary risk reserve to operate for a couple of months without a single submitted claim being paid.
The end result is a Wisconsin nursing home level of care population losing their personal supportive care provider placing them at higher risk for repetitive inpatients stays. Hospital budgets experience the change with Medicare penalties reducing reimbursement for repetitive inpatient stays. This can cause the parent health care organization of the rural Wisconsin hospital to question the locations fiscal integrity- and consider a closure.
The ripples are subtle but the analysis of this data is sound. A timely claims reimbursement process is essential to retain an adequate number of community providers needed to demonstrate the care assurance a standard of quality demands.
The staff of Home Care Path invite readers to watch this very real issue as it unfolds across the Wisconsin communities being served.
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