Providers: Need help with Managed Care recoupments due to Medicare updates in ProviderOne?

Washington State Health Care Authority sent this bulletin at 03/14/2019 01:30 PM PDT

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Get help with managed care recoupments due to Medicare updates in ProviderOne

What you need to do

If your claims for Apple Health (Medicaid) clients have been denied because of a managed care plan's recoupment (due to Medicare eligibility), please enter the following claim note when you submit your claim to ProviderOne:

MC RECOUP DATED [MM/DD/YYYY]

For claims denied due to timely filing

When the claim is resubmitted, it will be denied for timely filing and you must contact the Health Care Authority (HCA) with the claim numbers to be reprocessed.

For claims denied for another reason

If a claim is denied for another reason after it has been reprocessed, HCA will review the additional/new denial for payment and contact you with the outcome.

Please do not resubmit your request or the claim again after this resubmission. These requests are being worked in the order received.

How to contact HCA

Phone: 1-800-562-3022
Online: secure web portal

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than two million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and, beginning in 2020, the School Employees Benefits Board (SEBB) Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.