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Managed-care plans report claims, call-center and network progress; lawmakers ask for wheelchair-approval data
Summary
Healthy Blue, Sunflower and UnitedHealthcare gave operational updates to the Bethel committee — reporting claims paid, call-center performance, network counts and denial rates — while lawmakers asked MCOs for monthly reporting on complex wheelchair prior-authorizations and denials.
Three KanCare managed-care organizations updated the Bethel committee on implementation, network status and claims processing and described member outreach and local events.
Healthy Blue: Brian Beyer, Healthy Blue plan president, said his organization has paid about 1,000,000 claims since implementation and is averaging roughly $2.2 million paid in claims per day in March. He said Healthy Blue’s early focus was to "pay claims and answer the phone," reporting a member-call abandoned rate under 10 percent, average hold times around 60 seconds and strong provider-call response metrics. Beyer said credentialing and loading of provider records into KMAP are ongoing and that Healthy Blue aims to maintain an extensive primary-care network.
Sunflower Health Plan: Michael Stevens and Sunflower directors said the plan serves about 148,602 members (March snapshot) and reported 27,779 active providers in their network, including 4,682 primary care providers, 703 pharmacies and 835 HCBS providers. Sunflower reported high service-level metrics: 97.5 percent service-level attainment, seven-second average speed to answer and a first-call resolution rate above 91 percent. Sunflower also reported an average claims turnaround of 8.46 days year-to-date and an auto-adjudication rate of 95 percent; the plan said only about 1 percent of claims are received on paper.
UnitedHealthcare and Project ECHO partnership: Jenny Ismert, CEO of United's Community Health Plan, introduced a collaborative education initiative with KU Medical Center’s Project ECHO that trained rural clinicians and school-based providers on behavioral-health topics, antipsychotic use in older adults and lead-poisoning response. Doctor Shauna White of KU described ECHO as a tele-mentoring model that combines didactic modules with case-based learning; past ECHO series drew robust participation and continuing-education credit for clinicians.
Lawmakers asked the MCOs for more specific durable-medical-equipment data after stories from constituents about repeated denials for complex wheelchairs. Senator Erickson and Representative Bueller asked each MCO to provide monthly reporting on: initial prior-authorization denial rates for complex wheelchairs; average and median time to final approval; and to break out that data for wheelchairs ordered by therapists in certified seating clinics versus non-certified providers. The committee asked KDHE and the plans to return with that information at the next meeting.
Ending: MCOs and KDHE agreed to provide additional data requested by the committee, including more granular provider-type rosters and the wheelchair prior-authorization metrics the committee requested for monthly submission.
