The glitches were blamed on the Oct. 1 merger between Sunshine State Health Plan and WellCare of Florida. The agencies noticed the issues in December 2021, then worked with the state to rectify them in January.
However, the state said it was notified of the issues through outside entities, not from Sunshine or WellCare. The payer re-filed all unprocessed claims by Jan. 31, according to the Times.
The issues affected children participating in the state’s Children’s Medical Services Health Plan and Sunshine Health’s Medicaid program. Providers treating children covered by the programs were unable to file claims, causing unpaid bills to pile up.
The state is now investigating Sunshine Health to see if it violated its contract. If so, it may issue “liquidated damages and sanctions,” according to the Times.
The payer said about 0.5 percent of its 9.2 million claims during the period were affected by the mishap.
