July 27, 2013

Jason Helgerson Makes MLTC Encounter Data a Priority

At a Managed Care Policy Meeting held last week with managed care plans, New York’s Medicaid Director, Jason Helgerson, spoke about the importance for plans to submit timely and accurate encounter data.  He noted that managed long term care plan submissions are particularly late.  He indicated that if the lack of reporting continues there is the possibility that Statements of Deficiencies (which can result in halting enrollments) will be issued and that the Department of Health will consider referrals to the OMIG for investigation and audit.  The plans responded by explaining that the challenge, in part, is that they are not receiving the required information from the providers (home care, nursing facilities, adult day health care, etc). 

The takeaway here is that providers should expect to receive increased pressure to submit timely and accurate encounter data to plans. Most providers’ encounter data requirements are set out in their plan contract or alternatively, in plan policies and provider manuals.  Mr. Helgerson asked the health plans and industry associations present during the Policy Meeting to poll their member plans so that their concerns and challenges related to obtaining and submitting timely and accurate encounter data can be identified.

This post was contributed by Carla Williams. Carla can be reached at cwilliams@oalaw.com.