As the payer market in Georgia has consolidated through mergers/acquisitions; one of their key goals was increased efficiencies that they could leverage through size. Unfortunately, their provider partners have seen the exact opposite: consolidation has taken significant power out of the local state markets and placed it into national warehouses; whether that is claims appeals/provider loads and credentialing/etc. This national consolidation has slowed payer response and accountability to resolve issues.
Newly elected Insurance Commissioner Jim Beck recognizes that payers need increased accountability in Georgia and has, therefore, convened a stakeholders committee representing providers around the state; to identify the top four issues facing providers for the Insurance Commissioner to address with payer.
One of those key issues is provider credentialing and the typically slow processing of network loads; which is a statewide issue and a key focus of the complaints that they receive. It is evident that the payers in the state are not sufficiently meetings the challenges of provider credentialing.
Despite the universality of this issue, Commissioner Beck’s team shared that less than 10% of the overall complaints that their office receives are from physicians/hospitals. The DOI is simply not hearing from enough providers in this state to hold payers accountable to provider issues; in fact, medical complaints still represent the smallest percentage of insurance complaints received. Thus, the lack of complaints fails to trigger the additional scrutiny available from the DOI over payer activity.
The DOI’s resources are going to be devoted to the bulk of complaints that they received; therefore, SHP encourages our providers to ensure that they are utilizing the Department of Insurance complaint process. By appropriately reporting the myriad of payer issues, we believe that Commissioner Beck’s team will have a clearer picture of ongoing payer issues, thus direct their resources more actively in our assistance.
The DOI link is listed below in order to submit a Provider Complaint; including using the portal for electronic submission to DOI.