by Geoff Dornan

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April 18, 2014
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Audit lists Xerox's health exchange flubs

Auditors say Xerox is failing to meet nearly all of the performance measures in its contract with the state’s Silver State Health Insurance Exchange.

The firm Health Claim Auditors reviewed a long list of performance measures including such things as telephone wait times, handling of errors and complaints, turnaround times for those who signed up for coverage and accuracy of premiums and tax credits. To do so, it reviewed some 540 claims randomly selected from the exchange’s files.

HCA’s Bill Carr told the exchange board Thursday that, on a pass-fail basis, the vast majority of those measurements fail Xerox’s contractual requirements.

The company has a contract to provide not only the website where people can sign up for a health plan as mandated by the Affordable Care Act but the call center that accompanies it, worth more than $70 million.

Xerox representatives responded to some of the findings in the audit report but nowhere near all of them, prompting at least one board member to question the company’s commitment to fixing the system.

“It does not appear to me that Xerox is taking the report seriously,” said Leslie Johnstone. “This is a very serious report.”

Xerox issued a statement following the meeting saying it takes the audit findings “very seriously.”

“We are working closely with the exchange to resolve each issue identified in the audit and to implement audit recommendations that are prioritized by the exchange,” according to the statement.

Carr told the board that some of the problems are the fault of applicants making mistakes but that more than half the problems “are created by Xerox,” including such things as errors in the amount of subsidies poorer people signing up are entitled to offset their monthly health insurance premiums.

He said Xerox’s response times and other metrics have improved dramatically in the past month or so since the company added more staff at the call center and expanded the team working on the website. However, he said, the company is still falling short under the contract and should pay the penalties for noncompliance. Carr said, however, that the contract limits “aggregate damages” to no more than $25,000 or 5 percent of billings per month.

Board members especially questioned what is happening to people the exchange initially diverts to Medicaid as eligible under that program but who are then denied Medicaid for some reason. Thousands have been diverted to Medicaid by the exchange.

“If they’re denied, they’re told to reapply where, most likely, they would be transferred back to Medicaid again,” she said adding that it’s not fair to put those people in an endless loop.

She was told Xerox is dealing with those individuals.

Board members also questioned what Xerox is doing with those people who tried the exchange multiple times, setting up several accounts — in some based eight or nine accounts. Carr told them there is no link between those multiple accounts and that there may be as many as 50,000 of them. They were told Xerox is developing a way to find those accounts and eliminate duplicates.

The board is waiting until the end of the month, when Deloitte Consulting is expected to present its recommendations on how to fix the exchange.

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The Record Courier Updated Apr 19, 2014 04:33PM Published Apr 18, 2014 09:04AM Copyright 2014 The Record Courier. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.