Correcting Errors in Payments 400-29-55

(Revised 6/1/11 ML #3269)

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When it is discovered that a recipient failed to report or incorrectly reported income, deductions, assets, or the eligibility worker incorrectly calculated the recipient responsibility resulting in an error in payment resulted, the county currently managing the case shall rework the case in the Basic Care Resident Payment System. When making corrections to a given month, adequate or advance notice does not apply. Send notification to the recipient and provider informing them of the overpayment or underpayment and the reason.  Any changes to claims paid to providers will be processed by the Claims Processing Unit in the Medicaid Division based on receipt of form, SFN 639, "Provider Request for an Adjustment," from the provider.

• If the correction to the case is due to the recipient incorrectly reporting income, deductions, or assets, the corrections must be made in the Resident Payment System and notifications sent out from the date of the change forward.
• If the correction to the case is due to an eligibility worker incorrectly calculating the recipient responsibility, the correction is made in the Resident Payment System from the date of discovery forward.

 

When making corrections to a given month, adequate or advance notice does not apply. Send notification to the recipient and provider informing them of the overpayment or underpayment and the reason. Any changes to claims paid to providers will be processed by the Claims Processing Unit in the Medicaid Division based on receipt of form, SFN 639, "Provider Request for an Adjustment," from the provider.