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MEMORANDUM

TO: NIU Faculty and Staff

FROM: Steve Cunningham, Associate Vice President
              Administration and Human Resources

DATE: October 1, 2009

RE: CMS Update on Claim Payments for the State Employees Group Health Insurance Program

NIU is carefully monitoring the status of the State budget, in relation to university operations and related State-funded fiscal obligations such as the Monetary Award Program (MAP) financial aid program for students. 

Human Resource Services continues to receive inquiries and reports regarding claim payment delays associated with the Quality Care Health Plan (QCHP) and Quality Care Dental Plan (QCDP).  The State has significantly delayed payment of employee health insurance claims, which has greatly affected our employees and service providers throughout the community and region. We have received many reports that medical and dental service providers throughout the state are requiring/requesting that employees pay for services or enter into payment plans at the time services are provided.  Today, Central Management Services (CMS) posted a notice regarding the claim payment delays on the CMS State Employees Group Insurance website which can be accessed at: http://www.state.il.us/cms/3_servicese_ben_choice/defaultFY07.htm.

Generally, the notice indicates that QCHP claims processed through 3/7/09 for in-network providers have been released for payment.  Claims processed through 2/8/09 for out-of-network providers have been released for payment.  Thus, the current claims payment delay is approximately seven months for QCHP-contracted providers and eight months for non-QCHP-contracted providers.   Current dental payments are released 112 days from the process date of the claim.  CMS will periodically update this information as release dates are adjusted.

NIU will continue to monitor and urge the State to address this backlog of employee benefit claims and we will notify employees promptly of new developments or proposals regarding core Health Insurance and Pension benefit programs.