Blue Cross and Blue Defend of Minnesota is hiring greater than 300 folks because it prepares to deliver in-house work on Medicaid and associated state public well being applications that it began outsourcing in 2018.
The transition was rocky after Eagan-based Blue Cross awarded the contract for the back-office work to Amerigroup, a subsidiary of the big Indiana-based well being insurer Elevance Well being.
Data obtained this month by the Star Tribune present the state Division of Human Companies issued eight corrective motion plans between 2018 and 2020 towards the HMO division at Blue Cross, fining the corporate a complete of $13.15 million.
Dana Erickson, the chief government at Blue Cross of Minnesota, didn’t point out the troubles in an interview, saying the choice to deliver the claims processing and customer support work again in-house mirrored her deal with progress on the state’s largest nonprofit well being insurer.
“We’re naturally coming to an finish of our contract with Amerigroup, so it was a great time to essentially reassess,” Erickson stated. “We really see it as an enormous alternative for us to re-think the mannequin that now we have.”
Medicaid and the associated state public applications present protection for lower-income state residents in addition to sure aged/disabled populations. Service to the teams lined by the applications is “an essential a part of who we’re — an important mission,” Erickson stated.
The extra hiring already has began. At the moment, Blue Cross employs about 3,025 folks.
The outsourcing resolution pre-dated Erickson, who grew to become CEO in October 2021. Bringing the work again to Blue Cross is one in every of her most seen strikes in management to date.
“We’re very upfront, if you’ll, internally — if we speak about our objectives — on rising,” she stated. “There is not any cause that Blue Cross can not preserve and develop it is No. 1 market share, even with the competitors now we have.”
Blue Plus for many years has been a managed care group for enrollees within the state’s public well being applications. This month, the HMO is managing take care of practically 389,000 folks enrolled within the state’s well being care applications.
The Minnesota Division of Human Companies (DHS) says all eight corrective motion plans at Blue Plus have been resolved between 2018 and 2021.
DHS flagged quite a few issues, from delays in responding to prior authorization requests to charging sufferers the incorrect copay quantities for prescriptions. Whereas these two corrective motion plans and three others have been resolved inside 30 to 60 days and with out sanctions, there have been three that resulted in monetary assessments.
The largest — $7.49 million — stemmed from the insurer’s failure to offer correct and well timed fee of claims to well being care suppliers. DHS says the issue continued, unaddressed, for 2 years.
The troubles surfaced in spring of 2019. DHS notified Blue Plus that quite a lot of well being care suppliers have been complaining concerning the insurer not making well timed funds and wrongly denying claims. The complaints got here from suppliers throughout service areas, DHS stated, together with psychological well being for adults and kids, house care, medical gear and substance use dysfunction.
“DHS has critical considerations concerning Blue Plus’ failure to have correct oversight of its subcontractor, Amerigroup, and the failure to implement correct claims adjudication,” a DHS official wrote in a Could 31, 2019 letter. “DHS can also be involved concerning the period of time it takes Blue Plus’ subcontractor Amerigroup to implement options as soon as defects are recognized.”
The company stated it thought of the issue an “pressing matter and a breach of contract” and was involved about “the substantial chance of [this issue] adversely impacting a rising variety of enrollees.”
The issue continued, state data present, from March 18, 2019 by means of April 4, 2021, leading to sanctions of $5,000 per day for a 749-day interval.
The insurer additionally was sanctioned $5.55 million for an issue with processing sure claims for fee to federally-qualified well being facilities and rural well being facilities. Blue Plus was out-of-compliance for a complete of 555 days, DHS stated, from April 8, 2019 by means of October 13, 2020.
The division additionally imposed a $110,000 sanction associated to affected person complaints that they weren’t offered required transportation to well being care appointments from an Amerigroup subcontractor. DHS raised the problem in 2018 and it was resolved by November of that yr.
“All eight [corrective action plans] are associated to the Amerigroup transition,” DHS stated in an announcement to the Star Tribune.
Blue Plus stated in an announcement to the Star Tribune that it took a number of steps over the previous few years to deal with the problems outlined by DHS whereas enhancing enterprise associate agreements. The insurer stated it was “assured that now we have solved all of those issues in the course of the present vendor settlement.”
“As this contract will expire on the finish of the yr, Blue Cross is within the strategy of bringing capabilities again inside our Blue Plus HMO, with full staffing by Blue Cross associates in 2024,” the insurer stated.
Amerigroup stated in an announcement: “Via the efforts of each of our organizations, any earlier migration and implementation challenges have since been resolved.
“Blue Cross made a enterprise resolution to not renew our contract for 2024,” the insurer stated. “Amerigroup continues to collaborate with Blue Cross to uphold our contract promise and stay targeted on serving Minnesota’s Medicaid enrollees by means of 2023.”
The upcoming transition from Amerigroup to Blue Plus will warrant elevated oversight, DHS stated in an announcement, as with “any mission of this magnitude.”
“DHS will work carefully with the plan earlier than, throughout and after the handoff to assist facilitate a profitable transition and might be ready to require immediate remediation if any points are to come up,” the division stated.
Blue Cross already pays claims and handles customer support for different traces of enterprise, Erickson stated, so including Medicaid presents the prospect for extra effectivity.
“Bringing again in these sorts of capabilities provides us a chance to leverage scale internally and once more to check out some new, totally different options as we construct it,” she stated. “It is a strategic transfer in addition to one which I believe helps our core operations.”