VIEWS: 11 PAGES: 1 POSTED ON: 8/3/2011
Summary of OptumHealth New Mexico Sanction Resolution State of New Mexico Behavioral Health Collaborative Meeting January 7, 2010 October 29, 2009 Sanction Letter Sanction Resolution Directed Corrective Action Plan (DCAP) Optum agrees to comply with a revised, improved DCAP covering all the areas Directed Optum to take specific action in addressed in the original DCAP and the areas of claims, service registration, more, including provisions on “provider authorizations, funds mapping, provider relations” file audit and financial reporting. Civil Monetary Penalty Optum agrees to place $1 million into a fund to be used to compensate providers Lump sum fee of 1% of contract amount for increased administrative burden. for July 1, 2009 through October 30, 2009. Optum to distribute the fund as directed (Approx. $1.2 million) by the Collaborative. (The collaborative will work with providers to establish a Daily prorated 1% fee of contract amount fair distribution system). Payments to From November 1, 2009 until Optum’s begin as soon as Jan. 11, 2010 and payment provider system is working should be complete by Feb. 11, 2010. properly. (Approx. $10,000 p/day) Damages Optum agrees to pay the Collaborative $30,000, which is the approximate cost Assessed with the reasonable costs of the consultants’ fees. Optum will be incurred by the Collaborative because of held to their obligations under the Optum’s non-compliance (i.e. consultants’ contract to pay 1 ½ % interest on clean fees) claims. Optum to pay 1 ½ % interest on all unpaid claims. State Monitor Optum agrees to place a $500,000 deposit with the Collaborative from Optum assessed with the reasonable cost which the Monitor’s reasonable fees will of the State Monitor. be paid. Optum will support the Monitor until the Collaborative is satisfied Optum is fully performing or 6 months after all items in the DCAP have been completed, whichever occurs first.
Pages to are hidden for
"Summary of OptumHealth New Mexico Sanction Resolution"Please download to view full document