Chesapeake Healthcare urges state help as insurers delay FQHC claims, warns of funding gap

Brian Holland, CEO of Chesapeake Healthcare, told the Eastern Shore delegation on Feb. 21 that his federally qualified health center is facing prolonged unpaid claims, stalled rate negotiations with CareFirst and chronic federal underfunding that together threaten service access on the Lower Shore.

Holland said the clinic had the ‘‘same old responses’’ from insurers after an initial burst of attention: billing questions routed elsewhere, long timelines for resolution and repeated denials for administrative reasons. He said ‘‘we still haven’t received an answer about the behavioral health claims for their Medicare Advantage product’’ and that roughly 10 months of claims remained unpaid because the insurer did not advise the clinic of required billing steps.

The problem, Holland said, extends beyond CareFirst to a range of commercial carriers and Medicaid managed-care organizations (MCOs). He described coordination-of-benefits denials where carriers refuse claims because a secondary policy is present or because a patient’s coverage has lapsed; demographic mismatches (wrong birth date, name…