Review Of Maricopa Integrated Health System's Compliance With Medicare+Choice Prompt Payment Regulations During The Period May 1, 2003 Through October 31, 2003

The objective of this review was to determine whether Maricopa Integrated Health System Health Plans (Maricopa) complied with M+C prompt payment regulations to timely pay or deny claims submitted by noncontracted providers during the period May 1, 2003 through October 31, 2003. Maricopa's compliance with prompt payment regulations could not be determined because its claims processing data was inaccurate and incomplete. The data was inaccurate and incomplete because Maricopa did not (1) design and implement an electronic claims processing system that properly processed M+C claims and (2) establish adequate policies and procedures to record information necessary to properly track claims in its manual claims processing system. After completion of our fieldwork, Maricopa initiated a search for an outside contractor to process claims. We recommended that Maricopa (1) design and implement an electronic system, or contract with an outside organization, to process M+C claims correctly; and (2) establish adequate policies and procedures to ensure that all information recorded in the M+C claims processing systems is accurate and complete. Maricopa concurred with our findings.