July 1, 2015 and October 1, 2015 Medicaid Retroactive Rates

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From:  Angela Gazillio-Weidhorn & Vickie Guarraci

Below is the response from each MCO concerning adjusting claims affected by Medicaid retroactive rates.

Amerigroup:
They will not automatically adjust the rates.  Providers will be required to resubmit corrected claims with the adjusted rate.  Rates are updated as received from the state.

HNJH:
They are in the process of loading the rates now and they should be in production by the end of November.  If claims were submitted with a higher rate then HNJH will reprocess as soon as the rate for each Provider is updated.  Claims submitted with a lower rate will require the Provider to submit corrected claims with the higher rate.

UHC:
They are currently working on loading the 7/1/2015 and 10/1/2015 state rates. They have not provided a date of completion at this time.  When the entries are completed, they will run a second project to reprocess for the rate adjustment.

WellCare:
For nonpar Providers, rates will be adjusted and claims re-processed internally. Par Providers are not effected by rate changes due to the one rate payment exceeding the state’s perdiem.

Aetna Better Health:
Has no idea that changes in rates have occurred.  We have provided them with direction; however, not sure if they will pursue.

 

Please be advised if the MCO advised a “corrected claim” needs to be submitted, you will need to resubmit claims as identified as “corrected claim” with the new July 1, 2015 & October 1, 2015 Medicaid retroactive rates.

Take this into strong consideration going forward:  With the changes in perdiem rates occurring, it would be prudent for Providers to bill their Room & Board rates on claims to avoid the need to resubmit claims.  This would remove the excuse that the payer cannot make payments higher than what was billed.

If you have any questions, please call our office.

All correspondence from CARE is confidential and proprietary and is strictly intended for the use of its Members.

 

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This content is for Provider Members only.
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