Keith County authorizes reprocessing of out-of-network claims to restore Perkins County in-network access

The Keith County Board of Commissioners voted to ask the county’s benefits administrator to reprocess employee claims submitted to Perkins County since November after a negotiated agreement intended to make Perkins County effectively in-network for county members.

Perkins County representative Spencer told the commissioners the hospital had been working with its billing partner and insurer relationships after the facility was removed from a broader Aetna/CHI contract. Spencer said Perkins County agreed to have Meritaine reprocess claims that had gone out-of-network and to accept a negotiated discount on those charges: “they would allow us to go back and reprocess all of the claims since then,” Spencer said.

The matter matters to county employees and retirees who used Perkins County for care; reprocessing would convert previously out-of-network claims to the agreed discount arrangement, which may change how deductibles and out-of-pocket costs applied. Spencer told commissioners Meritaine was running a report to quantify the total dollar amount of claims to be reprocessed.

Commissioner Anderson moved to accept the reprocessing arrangement; the motion was seconded and approved on roll call. Commissioners recorded unanimous approval (Irvin — yes; Wartman — yes; Schroeder — yes; Anderson — yes; Crandall — yes).

County staff said employees who receive a denial for Perkins County care should bring the denial to the county so staff can route it to Spencer and Meritaine for reprocessing. Spencer said Perkins County also is negotiating directly with Aetna/CHI for a longer-term contract, but the reprocessing arrangement is an interim step to restore access.

The board did not vote to change plan benefits; it approved reprocessing previously denied claims under the negotiated arrangement with Perkins County’s billing contacts.