Why are Professional Billing claims delayed?

Problem: Physicians using full Connect Care professional billing services may have noticed delays in reimbursement from Alberta Health during December 2019. Those in alternate reimbursement plans (including AMHSP) will have noticed less, as their "shadow" billings do not immediately impact personal reimbursements. Nonetheless, delays are a worry. What happened?

Solution: While it is true that 1) professional billing volumes may have been temporarily reduced by productivity impacts of launch activities, 2) physicians learning a new system may not record charges with all requisite information, and 3) the naming of some billing codes needed revision... these understandable transition challenges were not the primary cause of December payment delays.

Alberta Health (primary source of payments) experienced an unplanned downtime of its professional payment system, resulting in delays to payments that were not related to the Connect Care system.

All Connect Care factors steadily improve, claims acceptance rates have returned to pre-launch norms for most physicians, and the AH downtime is over.

1 comment:

  1. We have received a comment from Crystal Weaschuck at Alberta Health providing some detail about recent claims submission challenges, now resolved:

    Alberta Health had identified a problem on December 27, 2019, that affected the payment amounts and payment reporting for the January 3, 2020 payment date. As a result, some payment amounts and payment/assessment reporting were not issued. The missing payments were issued on January 17th 2020. The statements of assessment have been generated and will be mailed out in the last week of February.

    Outside of the December 27, 2019 payment issue, in which all payments have been issued, normal claims processing and weekly payments continue to be generated.

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