HealthChoice vendor progresses with insurance claims

Unprocessed claims for Oklahoma's insurance plan for state employees and retirees have been reduced to an acceptable level, but the company processing the claims still must improve efficiency and customer service, an official said Friday.

The backlog of claims in the HealthChoice plan was about 200,000 in April, a few months after EDS took over processing claims from another firm.

Bill Crain, administrator of the board that oversees HealthChoice, said the backlog is about 57,000; work has been started on about 26,000 of them, but they need additional information to be processed, such as medical records or straightening out a deficiency in a name or identification number, he said.

"Those numbers now are certainly within the contractual requirements," Crain said. "It's now down at the level where we would ordinarily see it."

The previous vendor that processed claims typically had a backlog of 45,000 to 60,000.

However, because of the poor start by EDS and its effort to catch up, too many of the backed-up claims are 45 days or older, Crain said.

About 40 percent of them are at least 45 days old, Crain said. HealthChoice would like that number to be single digits.

Crain said EDS also needs to improve how it handles customers who call with concerns about their claims.

"They're continuing to hire and train additional people to actually man those phones in a way that would be conducive to meeting the performance standards (of the contract), and they're not there yet," he said. "We've seen some progress, just not nearly the progress we want to see."

At one time, about 40 percent of those calling with questions or concerns hung up because they were tired of waiting. The rate now is about 23 percent, with the goal of getting below 5 percent, Crain said.

The average time it takes for EDS to answer calls is nearly 12 minutes; one caller recently had to wait nearly 45 minutes. A caller shouldn't have to wait more than five minutes, Crain said.

HealthChoice, which has about 150,000 members and dependents, is losing about 7,000 members and dependents Jan. 1 when the state's regional university system, made up of about a dozen universities, including the University of Central Oklahoma, Southwestern Oklahoma State University and Northeastern State University, will leave the plan.