Days before its provider participation agreement was set to expire, the Tupelo-based health system and the Minnesota-based insurer announced Friday they had signed a three-year agreement and resolved outstanding questions about more than $40 million in disputed claims.
The agreement brings relief to thousands of people in the region who have United Healthcare through their employers, individually-purchased plans and Medicaid CAN coordinated care plans. United Healthcare’s Medicare Advantage plans that previously included NMHS facilities in their network are also covered by the resolution.
It covers the six North Mississippi Medical Center hospitals in Tupelo, Iuka, Pontotoc, West Point, Eupora and Hamilton, Alabama, as well as other NMMC facilities, affiliated physicians and clinics.
In a press release, leaders from both organizations said they were glad to find common ground.
“The silver lining of our dispute is that each of us has learned much about the other’s organization through the experience,” said Shane Spees, NMHS president and chief executive officer.
NMHS facilities cover more than 730,000 people in Mississippi, Alabama and Tennessee. United Healthcare has more than 600,000 people enrolled in Mississippi. An estimated 50,000 United Healthcare commercial insurance customers were potentially effected by the dispute.
“I appreciate that our two organizations were able to come together and reach a solution that will maintain our longstanding relationship and keep our focus on supporting the health care needs of the patients we collectively serve,” said Joe Ochipinti, chief executive officer of UnitedHealthcare’s commercial health plan in Mississippi
However, the organizations declined to offer specifics about how they reached a resolution, citing their agreement.
The agreement brings to a close months of public and private discussions over how United Healthcare paid North Mississippi Health Services. Last spring, NMMC staffers found electronic remittances from United Healthcare that were marked paid in full for $0. In arbitration papers filed in November, NMHS claimed more than $40 million as the result of breach.
United Healthcare maintained it had paid claims correctly. In its review of 2016 claims, United Healthcare staff said they found only 2.6 percent were underpaid, according to affidavits filed in Lee County court in connection with a civil lawsuit filed in December by NMMC. It said it had found $111,000 of overpayments to NMMC during the review.
NMHS went public with the dispute and its intention to terminate the provider contract in September 2016. On the original time line, NMMC-Tupelo would have been out of network for United customers at the end of December, followed by the community hospitals at the end of May and NMMC-affiliated clinics. Just before the December deadline, both sides agreed to a temporary agreement at the urging of Mississippi Insurance Commissioner Mike Chaney, that maintained the status quo through May 30.
Chaney welcomed Friday’s news of an agreement.
“The Mississippi Department of Insurance acted as a facilitator, encouraging a settlement between NMHS and UHC,” he said in a written response to Daily Journal questions. “As Commissioner, I am pleased the disagreement has been resolved.”
The Mississippi Insurance Department is still conducting a target market examination of United Healthcare, which is expected to be completed in June, Chaney said. Depending on the outcome of the report, the commissioner can order payment adjustments as well as levy fines based on the facts and the law.
The civil lawsuit filed by NMMC-Tupelo remains still active, according to the Lee County Circuit Court public record. The last notation in the file is a notice of May 18 hearing before Circuit Court Judge Jim Pounds. No orders had been entered in the public record as a result of that hearing as of Friday afternoon.
Hospital officials declined to discuss the status of the lawsuit, citing the agreement with United Healthcare.
United Healthcare is facing a federal lawsuit alleging it overcharged the Medicare Advantage program. United Healthcare denies wrongdoing. The federal lawsuit has no bearing on the dispute with NMHS, a United Healthcare spokesman said.
BEFORE YOU GO…
… we’d like to ask for your support. More people are reading the Mississippi Business Journal than ever before, but advertising revenues for all conventional media are falling fast. Unlike many, we do not use a pay wall, because we want to continue providing Mississippi’s most comprehensive business news each and every day. But that takes time, money and hard work. We do it because it is important to us … and equally important to you, if you value the flow of trustworthy news and information which have always kept America strong and free for more than 200 years.
If those who read our content will help fund it, we can continue to bring you the very best in news and information. Please consider joining us as a valued member, or if you prefer, make a one-time contribution.Click for more info