Four months after the switch to a new benefits administrator caused a massive claims backlog, the situation for Maryland mental health providers appears to be on the upswing. Even so, more repairs have to be made to the system before things can return to normal, state officials say.

A published report in late December highlighted the difficulties that arose when the state’s mental health department replaced its old contractor, APS Healthcare, with Norfolk, Va.-based ValueOptions. A projected $5 million savings prompted the switch.

From the start on Sept. 1, some providers struggled with a more detailed Explanation of Benefits field and a system function that caused massive confusion by automatically revising authorization periods. As a result, providers lost anywhere from $800 to $50,000 a month from payment delays, said Herbert S. Cromwell, executive director of Community Behavioral Health Association of Maryland.

Cromwell and Lori Doyle, chief operating officer of the Mosaic Community Services of Timonium, outlined the system problems for state legislators in mid-December. Since then the situation “has gotten better,” Cromwell said.

For instance, ValueOptions has created a manual workaround feature that prevents authorization periods from being automatically changed.

“Over time the issues will get fixed and overall the claims payment rate has been good,” said Cromwell, whose organization represents 50 mental health providers in the state. “We’re hoping by spring things will be back to normal.”

Though Doyle credits ValueOptions for being responsive and diligent in their attempts to make corrections, she maintains that for her agency “not a lot has changed and the basic struggles continue with the initial and ongoing authorization process.”

Other providers have seen improvement, such as the Maryland Mental Hygiene Administration.

“The first six weeks were pretty challenging, but things are getting resolved,” said Lissa Abrams, deputy director.
ValueOptions spokesman Lon Wagner conceded “there are small pockets of providers having difficulty with file set-up issues,” but that the company is working with Medicaid and MHA to resolve them.

“We successfully receive and process 1,000 authorizations every day from providers, so the system is working as it should.” Wagner said. “Overall, ValueOptions is paying between $11 million and $13 million per week in claims, the same as the previous vendor, which shows the system is functioning well.”