Oklahoma employee insurance board renews claims contract
By Michael McNutt
Comments 
2
Published: October 24, 2009
The company that got off to a shaky start this year processing claims for Oklahoma's insurance plan for state employees and retirees won unanimous approval Friday in getting its contract renewed for 2010.
The
Oklahoma State and
Education Employees Group Insurance Board voted 8-0 to approve the new contract with EDS, which last month was bought by the
HP company and is now called HP Enterprise Services.
After the vote, board
Chairman Richard Womack said board members are aware of problems that occurred when HP Enterprise Services took over processing claims for HealthChoice policyholders and their medical and dental care providers.
“We continue to push EDS to get to complete compliance,” Womack said.
Lola Jordan, a client delivery executive with HP Enterprise Services, told board members the backlog of claims is at about 53,000, a marked improvement since April, when the backlog reached more than 200,000 unpaid health and dental claims totaling $80 million to $100 million.
Bill Ritz, an HP Enterprise Services spokesman, said in a telephone interview that about 26,000 of the claims need additional information to be processed. Many of them are 45 days old or older.
Bill Crain, administrator of the insurance board, said some two- to three-year-old claims still need to be processed that originally were handled by the previous processing firm. HP Enterprise Services got into a jam when its computers could not read the data from the previous vendor,
Health Harrington. That company typically had a backlog of 45,000 to 60,000 claims.
Jordan said about 80 percent of new claims are automatically processed by computers, resulting in a two-day turnaround time. Crain said the industry standard is the upper 60 percent range.
This year's contract is worth about $17 million, Crain said. The contract for the next year calls for a slight increase and will also be close to $17 million, he said.
HP Enterprise Services has disputed the amount of money it's been paid this year, but Crain and Ritz said it's hoped a resolution can be reached shortly.
Ritz said HP Enterprise Services is bringing in more workers to help the 39 employees who handle telephone calls from policyholders and providers. HealthChoice has about 150,000 members and dependents.
At one time, about 40 percent of those calling with questions or concerns hung up because they were tired of waiting, Jordan said. The rate now is about 30 percent.
Crain said he would like to see the rate get below 5 percent.
The average time it takes for HP Enterprise Services to answer calls is nearly 12 minutes; one caller recently had to wait nearly 45 minutes. A caller shouldn't have to wait more than five minutes, Crain said.
Ritz said the calls span a variety of issues, ranging from policyholders asking eligibility and benefit questions to providers who may have questions about several claims.
Since January, HP Enterprise Services has processed almost 3 million claims and paid providers more than $470 million, Ritz said.
After Jordan gave her update on the backlog of claims and customer service problems, Womack, the board chairman, said: “Let's you and I make a deal — quit meeting like this. Let's set it as a goal that by the first of the year that we don't have to have this agenda item.”
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The last year with EDS HP is a case study in inefficiency!!! Sure the company has improved, but the 53,000 claims in queue are ridiculous. Of course there are 26,000 claims needing additional information because in many cases HPES has not accurately communicate with the doctors’ offices to let them know the claim is stalled awaiting supplemental information from them. Cutting the wait time to speak to someone on the telephone from 45 to 12 minutes is an embarrassment! After nearly one year HPES is still well behind the industry standard at 12 minutes and it is proud of cutting up to 33 minutes off the wait time!!! Even a five minute wait time is too long too!!!! The wait time should never be more than 2 ½ minutes. Believe me, there is nothing people like better than to be ill, worried about their claims and finances, calling a company that will make them wait 15 or more minutes (yesterday when I called HPES I waited 20 minutes before hanging up), then finally talking with an uniformed, poorly trained customer service rep that is more worried about getting you off the phone so his/her stats will look good at the end of the week than providing accurate, complete information about your claim! Doesn’t everyone look forward to such interactions?
Here is a suggestion for the OSEEGIB board members. Get out of the office and talk to people at the bottom of the process. Before the next renewal date for the HPES contract, conduct several external focus groups:
First hold four regional information-seeking meetings with 15-25 doctors’ office managers in each meeting. Ask them: Which insurance claims processing companies are the fastest and the most accurate? Which are the worst? Which have the easiest and fastest means of communication for them to use? What is their experience with HPEDS? Trust me, if you offer the office managers a free lunch and ask those questions you will learn more in one meeting than you have learned in a year of talking to the profit-and-marketing-oriented execs from HPES and their statistics.
Next hold the same kind and number of meetings with a representative sample of the 53,000 individuals with claims awaiting attention or additional information. Ask them about their experience with HPES. How the HPES organization communicates with them and the timeliness of communications, how communication with HPES is initiated, how their doctors and providers view HPES?
Finally, both set of groups will have provided great ideas for improving customer service and claims processing at HPEDS so take all of this information and share it with HPES executives, the ones with whom your normally meet, and ask them to develop an improvement plan with a timeline to make specific, measurable improvements on each key point and determine realistic, but significant, penalties for nonperformance. Then hold them to it and demand the penalties if they don’t perform.
For instance, my doc’s insurance office manager told me yesterday she had to wait 25 minutes to talk to someone when she called HPES about my 10 month old claims. Perhaps there should be a 2 ½ minutes standard for providers calling HPES and if it isn’t met HPES would forfeit 2 ½ % of the total claim amount to OSEEGIB. This is probably a little unrealistic, but I am sure everyone gets the idea. I’ll wager if there were real, enforced financial penalties in the contractual agreement with HPES for not meeting predetermined, meaningful standards, the OSEEGIB would receive enough revenue to avoid raising the premium rates for state employees, or HPES would change and improve their services to be befitting of the insured employees. Either way the insured employees WIN!
Richard and Bill, PLEASE STOP supporting the inefficiency at HPES with our insurance premium dollars!!! Do something positive during the upcoming contractual year to require HPES to correct their poor performance or find a different proven, reliable, effective, efficient, communicative, customer friendly claims processing organization to contract with next year. Don’t be duped again next year for millions of dollars for so little benefit to the insured employees. The employees and retirees of Oklahoma DESERVE BETTER!!!