OSF HealthCare claims Meridan delays, denials cost millions

Local News

PEORIA, Ill. — After it was announced last week that OSF HealthCare would be cutting ties with Meridian, OSF HealthCare said the provider owes OSF “millions of dollars.”

OSF HealthCare previously issued a notice of termination to Meridian effective Dec. 15. OSF is claiming the company owes them money for outstanding claims for services provided over the last five years.

“We are unfortunately at a standstill with Meridian because for years they have failed to honor the most basic components of our agreement and will not come forward to resolve outstanding accounts,” said Randy Billings, OSF HealthCare senior vice president of population health. “We are concerned for Meridian members, which is why we contacted the Illinois Department of Healthcare and Family Services and Meridian members to make them aware of the situation.”

OSF HealthCare said they issued the termination after months of discussions with Meridian. This comes after years of OSF accepting Meridian Medicaid and Medicare plans.

“Meridian’s inability to pay claims per industry standards within the contractually required amount of time has created an unmanageable administrative burden for OSF in billing for services it provides,” said Billings. “Meridian’s demand that OSF resubmit claims that were properly submitted is completely unreasonable. It is our mission to serve persons with the greatest care and love.”

OSF said Meridian members who want to remain with OSF providers can choose a different managed Medicaid plan during the open enrollment period, which is now underway. OSF HealthCare participates in IlliniCare and Molina Medicaid plans.

“Receiving the contractual reimbursement that OSF has earned for services provided is important to ensure that we can continue to meet the needs of those we are called to serve,” Billings said.

Additionally, OSF will work collaboratively with Meridian and its members to ensure a safe and clinically appropriate transition of care as needed.

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