Rocky transition for region D MAC

Sunday, January 14, 2007

YARMOUTH, Maine - Many providers in Region D are juggling checkbooks as unpaid clams mount.

The problems started when Noridian replaced Cigna as the Medicare contractor for the region July 1.

"It's a train wreck," said Becky Ruecker, compliance officer for Portland, Ore.-based Care Medical, which has nine branches in Oregon and Washington.

"I have been in contact with the claims supervisor at Noridian and she's telling me that claims unable to be handled automatically are having to be hand processed," said Ruecker. "Our claims are just dogpiling."

The company has passed the $1 million mark in pending claims.

Tim Pederson, CEO of Rapid City, S.D.-based Westmed Rehab, said his cash flow is down $100,000.

"Claims are approaching 60 days, and that doesn't include the hearings and appeals claims that are stuck in limbo," said Pederson. "I know the contractor is working very hard, but I think they are in over their head."

Some of the problems can be attributed to a normal degradation in service when regimes change, said one CMS official. Staff isn't fully trained, and the contractor may have underestimated claims volume.

"Noridian does have some issues, but we're very much aware of it," said the official. "They've added some staff to work on the manual suspension claims, and they are going to be adding more staff in the coming weeks."

Mark Ehlers, owner of Stockton, Calif.-based Ehlers Medical Supply, said he's been forced to ask manufacturers for extra time to pay invoices. He calls Noridian weekly.

"All we get is 'they are in process,'" said Ehlers. "They are nice folks but very disorganized."

The CMS official said pending claims should drop to more satisfactory levels in February.

CMS said providers with issues should contact Noridian's call centers. If they feel they are not getting any resolution, they should contact Larry Young, CMS project officer for Region D, at