The Commonwealth Healthcare Corp. and all facilities within the corporation has stopped accepting TakeCare Insurance effective yesterday.<\/p>\n
The suspension came about after TakeCare Insurance declared that CHCC is not a participating provider in TakeCare\u2019s provider network.<\/p>\n
CHCC CEO Esther Mu\u00f1a characterized this a \u201csudden claim by TakeCare\u201d and described it as \u201ca weak attempt\u201d to evade payment of arrears to the hospital.<\/p>\n
\u201cWe have been trying to work with them for weeks to have the bills in the hospital get settled and paid. We have offered prompt payment discounts, provided many deadlines in order for them to compy, and initiated work settlements so both of us can move forward. Despite that, they kept dragging and delaying the process,\u201d said Mu\u00f1a.<\/p>\n
She said that TakeCare representatives have denied legitimate and documented claims, saying some claims are inaccurate and even went as far as saying that the claims bears the wrong text I.D. numbers. <\/p>\n
\u201cWe recognize that all of those reasons are delaying tactics,\u201d Mu\u00f1a added. <\/p>\n
In a statement last night, TakeCare announced the completion of reconciliation of the CHCC\u2019s claims from 2012 to June 30, 2017, that were submitted in June 2017.<\/p>\n
\u201cAs of today, TakeCare has found that there is still an unapplied balance of $226,653.50 from the original advance of $1 million made to CHCC. As this balance is considered an excess payment to [CHC], TakeCare does not owe any further payments for historical claims,\u201d the statement added.<\/p>\n
TakeCare said it has received notification that CHC \u201cwill no longer serve as a network provider to patients with TakeCare Insurance.\u201d <\/p>\n
\u201cTakeCare would like to make clear, despite CHC sending bills for services rendered directly to TakeCare, TakeCare members have always been self-pay patients at CHC as both parties have not entered into a provider service agreement.<\/p>\n
\u201cHowever, as a professional courtesy and as a matter of convenience for CHC, TakeCare has customarily accepted billings from CHC for covered services rendered to its members, and made payment to CHC subject to policy limitations and the benefit terms of its policies.\u00a0<\/p>\n
\u201cIt is our sincere hope that CHC will continue to work with TakeCare to address the claims process, including working on terms of a Direct Payer Agreement,\u201d the statement said.<\/p>\n
In an interview last month, Mu\u00f1a said the majority of the insurance claims from different insurance companies recognized by CHCC are from the last two years. <\/p>\n
Some of them even goes as far back to 2012 but the reality is that majority of those claims, Mu\u00f1a said, are from the last two years and are collectible. <\/p>\n
Last August, CHCC hired Tiffany Sablan as Revenue Cycle director and her hiring and other improvements in CHCC\u2019s revenue cycle has resulted in updated financial processes in the hospital\u2019s billing and collection system.<\/p>\n
To date, TakeCare insurance owes CHCC a total of $2.9 million. Last month, TakeCare gave CHCC a $1 million good-faith payment to allow both organizations to reconcile outstanding claims and to provide no disruption in services to TakeCare members.<\/p>\n
According to Mu\u00f1a, the $1 million payment and the negotiations that occurred are all indicators that TakeCare and CHCC had a working relationship. <\/p>\n
\u201cIn fact, there was a letter signed by all insurance companies including TakeCare in 2013 when CEO Juan Babauta was seated, agreeing to the health plans outlined by CHCC, which included room rates, operating room charges, CPT procedures, and for TakeCare now to say that CHCC is not a participating provider in their network is upsetting.\u201d Mu\u00f1a said.<\/p>\n
TakeCare Insurance said their members are now self-pay patients. Currently, TakeCare\u2019s health plans have over 30,000 members in the CNMI. <\/p>\n
CHCC continues to provide healthcare to TakeCare insurance members, but they will be responsible to pay in full upfront. <\/p>\n","protected":false},"excerpt":{"rendered":"
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