Lawmakers Press DHS, Insurers and PASS Plans Over Delayed Provider Payments and Enrollment Backlog

Lawmakers and providers pressed the Arkansas Department of Human Services (DHS), the Insurance Department and the state's three PASS plans on April 24 over widespread payment delays and a backlog of provider enrollments after the PASS model moved to full-risk billing on March 1.

The hearing, convened by the Senate State Agencies & Governmental Affairs committee, focused on technical failures that have left providers unable to submit clean electronic claims and forced some to wait weeks for reimbursement. Alan Kerr, Arkansas Insurance Department commissioner, told the committee the department's role is to regulate PASS organizations for financial solvency and to enforce risk-based capital rules, including an initial $6,000,000 capital requirement that PASS entities must meet to be licensed. He and other insurance officials said benefit design and provider-payment timing fall under DHS jurisdiction.

Providers and advocates described the immediate impact. Joel Landreno, executive director of the Arkansas Behavioral Health Providers Association, said many members are struggling to remain solvent after claims were denied or held because provider records did not match PASS billing systems. Stephanie Smith, chief operating officer of Easterseals, said coding and billing edits (NCCI/CPT and bill-type mismatches) and inconsistent requirements for National Provider Identifiers (NPIs) have prevented claims from matching the PASS systems. She estimated 30 to 60 days to reprocess denied claims and urged DHS to delay the May open-enrollment effective date so transitions do not disrupt continuity of care.

DHS officials acknowledged problems and described immediate and near-term remedies. Director Cindy Gillespie said her agency deferred the rollout from Jan. 1 to March 1 after readiness reviews and established a command center to run seven days a week during launch. DHS reported about 450 outstanding new provider-enrollment applications in-house, with an average processing time near 48 days; the agency proposed additional staffing, an enhanced online portal and a target to reduce online complete-application turnaround to 30 days by August 1 and to materially reduce the backlog by June 30.

PASS leaders told legislators they have implemented short-term workarounds. Representatives of Arkansas Total Care, Summit Community Care and Empower said portal and system fixes were being deployed to accept claims that supply either a Medicaid provider number or an MPI/NPI, and some plans reported issuing accelerated payments by wire to affected providers on a case-by-case basis. Jason Miller of Summit said plans can and have expedited payments within days for verified claims.

Lawmakers demanded more transparency and documents. Several members asked DHS and the PASS plans to provide copies of readiness-test reports, provider-contract terms and claims-inventory figures; DHS agreed to provide its readiness-review reports "by tomorrow" and to share daily ticketing and complaints data. The committee scheduled follow-up oversight in roughly two weeks.

What happens next: DHS and PASS officials said they will continue technical meetings with providers, implement short-term fixes that allow claims with Medicaid IDs to be accepted, expand provider-enrollment capacity and report back to the committee on timelines and outstanding claim inventories. The committee asked for documentation of testing, contractor reports and contract samples from PASSs and DHS at the next session.