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County approves MOU with Heritage Health Solutions to reprice inmate medical claims under vendor terms
Summary
The county approved the mayor's signature on an MOU authorizing Heritage Health Solutions to reprice and administratively manage off-site inmate medical claims; the MOU describes billing at 205% of Medicare allowables, a $20 processing fee per claim and monthly invoicing.
Cheatham County commissioners on Dec. 16 approved an agreement allowing Heritage Health Solutions to provide administrative repricing and claims-management services for inmate medical care that occurs off-site.
The Memorandum of Understanding, presented by County Mayor Kerry McCarver and approved by roll-call vote, designates Heritage as the county’s third-party administrator for off-site outpatient, emergency department and inpatient claims that the county is financially responsible for. According to the terms attached to the MOU, Heritage will negotiate provider participation in its network, process off-site claims and invoice the county monthly. The Heritage invoice format described in the attachment includes the billed amount, the Medicare price and the invoiced amount to the county; Heritage’s standard fee language in the submitted documentation says the invoiced amount will be 205% of the Medicare allowable amount for a claim and that Heritage charges a $20 processing fee per claim for adjudication and denials processing.
Heritage’s MOU lists a one-year initial term, 30-day invoice payment terms, and a 45-calendar-day payment target for in-network providers by Heritage. The MOU also describes reporting, a toll-free customer line and an account manager to assist day-to-day. It allows for Heritage to negotiate local provider participation in a Heritage network and to provide accrual reports when the county provides a weekly off-site visit report. Heritage’s documentation states it will handle appeals with providers and that run-out claims may be processed for up to six months after termination of the MOU.
County officials did not expand in the public minutes on the projected fiscal impact of the new arrangement; the meeting packet contains the MOU and Heritage’s Attachment B (Fee Schedule) with the repricing and fee language. Commissioners voted to approve the mayor's signature on the MOU; the record shows the vote as unanimous.
What stakeholders should know: if the county proceeds under the MOU, Heritage will repriced billed claims before invoicing the county. Heritage's fee language — invoicing at a stated percentage of Medicare plus a per-claim processing fee — is included in the materials presented with the MOU at the meeting. The county will receive monthly invoices and accrual reports where requested and will pay Heritage within the MOU's payment terms. The Sheriff’s Office will coordinate implementation.
Next steps: the Sheriff’s Office and Accounts department will coordinate to implement the MOU and integrate Heritage reporting and invoicing into county accounting.
