Recoupment
1.) Rate Change
July/Augst 2 month contract delay
Prior fiscal year payment held for July and Aug but then all those rates (July and August)
Files needed:
HCI send us the rate (Ken also has)
Cap files
Alyssa sends a report to State
2.) Correct payment
New benefit for SUD Jan
Whats the code for the payment?
Similar to rate change, started 1/1/2021
Rev increased from 50pmpm to 52pmpm (as an example)
What is the code that shows the payment increase?
No code in file?
WE have to ensure that the $52 pmpm came in for each member
Files:
Similar to rate change Elig member
3.) Date of Death recoupment
HMS auditing contract w/State
Cathy would dl the dod file , send to CO IT and analyze
No longer from HMS
Did we get a payment?
Is the member the State taking money back on actually shows a service?
DOD taking $ , Claims and Encounters
Example: John Doe passes away what happened to the payment during the month he passed away. This should not be taken if it was never given.
4.) IMD (Inst Med Disease) recoupment
Send them How many days a member has > 15 day stay
Sometimes BH pays > 15 day w/HCI money
State will take back initial revenue capitation (gradiated by age/gender) payment
Claims
Originally file from State was focused on recoupments? 820 file Code "03"
Tina : Can we get other codes?
Codes in payment file? Dana