Staff Readiness Services

Credentials Verification Services

Credential Verification Services saw an overall increase in volume from 2020 with 4,092 completed files, an increase of 18%.  Our Customer Service team completed 4,169 help desk tickets created through inquiries received via phone and email, seeing an 8% increase in volume.  Our services continue to provide high-quality verification services to ensure regulatory and customer requirements are met!

Highlights from 2021:

• Successfully completed our bi-annual National Committee for Quality Assurance (NCQA) audit, maintaining our ongoing accreditation for eleven out of eleven verification elements through April 3, 2023.

• Continue to provide industry-leading turnaround times for completing credentials verification files at 16.99 days from the time a completed application is received.

• Grew our customer base with new credentials verification customers across several states.

• Partnered with New Mexico Medical Board to update the online application, which allowed HSC to process DO applications in addition to MD applications.

• Streamlined File Maintenance and Itemized Request pricing.

Risk Management

Workers’ Compensation Services

Hospitals throughout the state continued to see an increased number of patients due to COVID and general health conditions that went untreated.  We continued to handle COVID-reported workers’ compensation claims under the Executive Order from Governor Lujan-Grisham, which stated that a presumption that health care workers carry a far greater risk of being exposed at their workplace. COVID claims represented 15% of claims filed in 2021, down by 4% from 2020.

   Highlights during 2021 include:

• NMHWCG Board members were instrumental in increasing the group discount rate to 33.1%, which was 4.9% higher than the 2021 discount rate.

• Our claims handling and loss prevention services continue to facilitate an excellent relationship with the excess carrier.  Our members saw a very slight increase in rates for 2022 policies of 1%.

• The premium discount task force continued working on programs to make these more behavioral-based programs and put the control back in the hands of the members.  The Safe Patient Handling program was reviewed in 2021, and through this process, we identified a significant increase in workplace violence against healthcare workers.  Changes were made to the program to ensure that all employees are aware of potential patient issues to avoid attacks.

Unemployment Compensation Services

In 2021, Unemployment Compensation Services continued to see increased claims filed. There were 6,129 claims filed which was a 16% increase from 2020.  The Department of Workforce Solutions (DWS) faced many challenges in processing claim responses timely, and the undetermined claims for 2020 and 2021 remained high. 

Fraud claims consumed employers, employees, UC Analysts, and DWS.  In 2021 fraud claims represented 40% of all claims filed.  Identity theft and Program Fraud are the two categories that the DWS investigates once responses are received.  Employees who compromised their identity had to complete identity theft affidavits and file a police report to submit to DWS.  Program fraud claims are identified after the fraud investigation is completed and it is determined that an employee intentionally filed a claim for benefits while still employed.

This past year we achieved the following:

• Ongoing requests to DWS to discuss concerns regarding benefit charges, interest and liens, and the high number of undetermined claims.

• Provided feedback received from our customers to make many needed enhancements to the HSC UC Portal.

HealthXnet

We listened and responded to our customer feedback survey, and with continued enhancements and improvements to the HealthXnet portal, customer satisfaction scores increased in 2021. Our software continues to be the one portal, one login solution for a growing number of subscribers making millions of eligibility and claims inquiries every year. The ease and efficiency of the HealthXnet tool allows front-line employees to quickly verify eligibility and benefits inquiries. This is a critical step toward obtaining accurate and detailed information for patients, which in turn can lead to higher patient satisfaction levels and fewer claims denials.