Recoupment
Originally file from State was focused on recoupments? 820 file Code "03"
Codes in payment file? Dana
Tina : Can we get other codes?
4.) IMD (Inst Med Disease) recoupment
Claims
State will take back initial revenue capitation (gradiated by age/gender) payment
Sometimes BH pays > 15 day w/HCI money
Send them How many days a member has > 15 day stay
3.) Date of Death recoupment
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.
Cathy would dl the dod file , send to CO IT and analyze
No longer from HMS
Is the member the State taking money back on actually shows a service?
DOD taking $ , Claims and Encounters
Did we get a payment?
HMS auditing contract w/State
2.) Correct payment
New benefit for SUD Jan
Similar to rate change, started 1/1/2021
Files:
Similar to rate change Elig member
Rev increased from 50pmpm to 52pmpm (as an example)
WE have to ensure that the $52 pmpm came in for each member
No code in file?
What is the code that shows the payment increase?
Whats the code for the payment?
1.) Rate Change
Files needed:
Alyssa sends a report to State
Cap files
HCI send us the rate (Ken also has)
Prior fiscal year payment held for July and Aug but then all those rates (July and August)
July/Augst 2 month contract delay
