TUPELO – Subsequently after hearing from both North Mississippi Health Services and United Healthcare, Insurance Commissioner Mike Chaney wants to bring the arguments together.
“As a result of our analysis of the Oct. 21 status reports provided by UHC and NMHS, the department is in the process of planning a meeting with the parties in an effort to assist an amicable resolution,” Chaney stated in a statement on late Friday.
At the end of September, Tupelo-based North Mississippi Health Services proclaimed it would dismiss its provider contract with United Healthcare for 2017 because it had not been able to resolve issues over incorrect payments which is discovered in April.
Because of the potential effect on consumers, the Department of Insurance became involved with the dispute early this month.
“Should this meeting fail to provide substantial results, the department is prepared to take regulatory action,” Chaney stated.
Regulatory actions could contain payment adjustments, fines and other penalties.
Leaders with both United Healthcare and North Mississippi Health Services stated they want to see the issue resolved.
“We will continue to inform the Department of Insurance on the important progress we are making on the claims payments to NMHS,” stated Elizabeth Calzadilla-Fiallo, public relations director for Florida and the Gulf States Region for United Healthcare. “We believe the health system will honor its agreement with United Healthcare and continue serving our members’ health care needs as we work toward a resolution.”
Officers with North Mississippi Health Services were unavailable for comment Thursday.
In the spring, NMHS found electronic repayments were coming in from United Healthcare, marked as paid, but for $0. In mid-October, the health system shared its research with the company.
Could not recover products.
United Healthcare leaders stated the company’s internal investigation has not found the same issues.
“An initial test group of the claims North Mississippi Health System provided has shown several were in fact paid correctly,” Calzadilla-Fiallo stated in a statement.
If the termination goes into effect, North Mississippi Medical Center-Tupelo would go out of network for United Healthcare customers on Jan. 1. NMMC community hospitals in Pontotoc, Iuka, Eupora, West Point and Hamilton, Alabama would go out of network May 22. North Mississippi Medical Clinics would be exaggerated on Aug. 14.
The out of network status would affect people with United Healthcare policies obtained individually or through their employers, Medicare Advantage policies through the insurer and Mississippi Medicaid CAN participants who used United Healthcare’s coordinated care network. About 7 % of North Mississippi Health Services patients are covered by United Healthcare.