For weeks, FOX8 has reported stories about NC Tracks and local providers’ frustrations with the state’s new online Medicaid billing system.
Doctors, therapists and billing experts we’ve talked to say they are not being properly reimbursed for Medicaid patients’ bills.
FOX8 went to the state’s capital last week to discuss the details of an audit released in May that expressed concerns with the project and whether it was ready to go-live July 1.
“This was a huge system. This was a major overhaul,” explained State Auditor Beth Wood. “My staff came forward and said we really need to step in here.”
Auditors found that “the Department [of Health and Human Services] has failed to fully test the system,” writing in the audit that the testing process had flaws.
For example, the NC Tracks team was supposed to conduct 834 critical priority test cases. “There were 285 critical tests that should have been performed and they were not,” said Wood.
The lack of information about those nearly 300 tests “increases the risk that the Vendor underreported the severity of defects to meet acceptance criteria and could lead the Department to inadequately assess the overall production system testing and encounter issues on go-live,” reported auditors.
The “vendor” refers to Computer Sciences Corporation (CSC), the company that designed and developed NC Tracks.
A verification services vendor, Maximus, should have independently verified CSC’s reports about what was and was not working, explained Wood. Auditors found that “Maximus relied exclusively on the test result reports of other vendors to conduct its own test case analysis.”
In addition, the auditors were concerned that DHHS created a conflict of interest for CSC in the testing process, reporting “the vendor built the system, tested it, and proposed the criteria for the Department to accept the system’s production readiness.”
Essentially, they said there was no information independent of what CSC reported to double-check whether NC Tracks was on track.
Auditor Wood says she took their concerns and recommendations to DHHS. “It was up to DHHS if the cost outweighed the benefit… They were in agreement that some [concerns] were extremely critical and went to work basically, according to them, around the clock trying to fix everything that we had identified.”
So why did the state go live with NC Tracks July 1, with so much at stake? Especially, according to auditors, when “a high risk exists that critical NC Tracks functions could have major errors on go-live.”
Auditor Wood said the answer is, in part, because of funding. “The federal government said they were not gonna pay for two system to run here. So we were coming up on a deadline, the state of North Carolina was, that had we not gotten the new system implemented, they were going to be pulling their 90% they’d been paying.”
In that case, she explained, the cost of finishing the project would fall on state taxpayers. “It would have been a huge drain on the state of North Carolina,” Wood pointed out.
Earlier this week, FOX8 asked Governor McCrory about NC Tracks. He said only 1 to 2 percent of providers were having problems. “We are still needing to train local county officials on how to implement this brand new system that, frankly, we inherited.”
Auditor Wood pointed out the NC Tracks project started in 2004 after the federal government said the system needed to be upgraded. “It went from initially costing over $167 million to over half a billion dollars.”
“This administration really had a lot to do in less than six months,” Wood explained. “So while I’m not surprised with the issues that came about, I’m a little surprised that it could even go live July 1.”
The Department of Health and Human Services told FOX8 Friday, “Before NC Tracks launched, DHHS benchmarked with several states that had undergone similar technology upgrades for their Medicaid systems. Without exception, they informed North Carolina to expect a rough transition during the first 60-90 days. So far, 47 days into NC Tracks operations, those other state have been proven correct.”
In an email statement, DHHS Communications Director Ricky Diaz continued, “Although NC Tracks has processed more claims than it has denied, DHHS realizes this is small comfort to those providers who have not received payment. DHHS has a stake in making sure providers continue to care for our state’s most vulnerable citizens; providers who are not paid for work already performed cannot pay staffs or keep their doors open.”
He added, “We are committed to bringing all 70,000-plus providers in this state up to speed, and we are taking aggressive steps to reach out to individual providers who continue to have difficulties with NCTracks.”
NC Tracks has now processed more than 15 million claims that paid health care providers more than $1.1 billion, according to Diaz.