Medicaid Billing Issues Affecting Rochester Health Providers

A resolution regarding Medicaid billing is offering some relief for health care providers in Rochester, but one clinic is still in limbo. Recently, it was reported that three local Medicaid providers faced potential disenrollment from the program, which would mean halting their services. As of now, two of these providers have managed to resume charging for their services after appealing, but OWL Therapy Services finds itself in an uncertain position.

“There were so many tears in the waiting room this week from all sides,” remarked Lauren Glessing, the owner of OWL.

OWL focuses on helping both children and adults enhance their communication and language skills. However, the clinic had to stop providing Medicaid-funded services as part of a statewide initiative aimed at improving oversight due to misconduct.

A federal mandate had required the Minnesota Department of Human Services to investigate nearly 5,600 high-risk Medicaid providers by the end of May. Out of this total, over 3,400 had their registrations canceled due to either incomplete paperwork or unsuccessful certifications.

In response to growing concerns from both legislators and providers, the DHS announced this week that it would lift payment suspensions for organizations that appealed by Tuesday, and all three Rochester providers did so.

Unfortunately for OWL Therapeutic Services, it was not included in the notifications sent to Family Service Rochester and EA Therapeutic Health.

Glessing said the clinic first became aware of the issues in March when Medicaid claims began to be denied. Upon reaching out to the state, she learned that OWL had been suspended and was instructed to submit revalidation paperwork as part of the Revalidation 2026 initiative.

The clinic submitted its documents the subsequent week and has been awaiting a review for several months. However, the DHS claims that OWL was never part of the high-risk provider review and was instead deregistered for not responding to several requests for recertification—a claim Glessing contests.

“They said they mailed it to this particular office, which has someone here all day every weekday, and we have never received any notice in the mail,” Glessing stated.

Despite multiple attempts to reach the state, Glessing is still in the dark about whether OWL can resume providing services to the families who rely on them. She mentioned that she has already informed around 20 families that she can no longer assist them.

In light of the circumstances, the Minnesota Department of Human Services is granting providers an extra 24 hours to submit claims for this payment cycle, extending the deadline to Friday at 11:59 p.m.