Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth All Provider Bulletin 171 January 2008 TO: All Providers Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: Credit Balance Overpayment Policy Background Providers participating in MassHealth are required to return overpayments classified as credit balances to MassHealth within 60 days of their receipt. Credit balances can occur, for example, if you have received payment from MassHealth for a claim for which reimbursement has been received from third-party payers, such as Medicare, private insurance, or worker’s compensation. Administrative MassHealth may impose administrative fines against providers who do not return Fines for Failure overpayments classified as credit balances within 60 days of their receipt, per to Comply 130 CMR 450.238(B)(7). To avoid such administrative fines, you should conduct periodic reviews of your financial records to identify and refund credit balances owed to MassHealth. Waiver of From the time you receive this bulletin until February 1, 2008, MassHealth will Administrative waive its right to impose administrative fines on credit balances identified and Fines listed on the attached Credit Balance Response (CBR) form. This amnesty waiver does not apply to any previously conducted, current, or notification of intent to audit, or to any Attorney General Medicaid Fraud Division activities. Review You should review your records to ensure that you have identified all outstanding Your Records credit balances. Report your credit balances on the attached CBR form. The CBR form is available on MassHealth’s Web site, where it can be filled out online and printed for submission. Any provider taking advantage of this waiver program must certify that it has procedures in place to ensure compliance with the requirement to return overpayments within 60 days. Note: The CBR form will be available online only until the close of business on February 1, 2008. To access an online copy of the CBR form, go to www.mass.gov/masshealth. Click on the link to MassHealth Provider Forms located in the bottom right corner. Providers may use Microsoft Excel or Access spreadsheets to itemize credit balances, but must still complete the top half of a CBR form and sign it to certify compliance procedures. Please attach it to your spreadsheet, making sure that the spread- sheet includes all information required by the CBR form. (continued on next page) Review In order for your claims history to be adjusted, you must also submit a remittance Your Records advice highlighting the claim and the amount to be voided or adjusted. (cont.) Do not send a check to MassHealth. A recoupment account will be set up for the amount of the credit balances listed on the CBR form, and the corresponding remittance advice. Unless other arrangements have been made, MassHealth will recover 100% of your claims payments until the amount recovered equals the identified credit balance amount. Credit Balance Send your fully completed and signed CBR form postmarked by February 1, 2008 Response Form to MassHealth Financial Compliance Unit The Schraffts Center 529 Main Street, Third Floor Charlestown, MA 02129 Questions If you have any questions about the information in this bulletin, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974. Commonwealth of Massachusetts Executive Office of Health and Human Services www.mass.gov/masshealth Credit Balance Response Form Return to: MassHealth • Financial Compliance Unit • The Schraffts Center • 529 Main Street, Third Floor • Charlestown, MA 02129 Name of Provider NPI Address Business Phone No. City/Town State Zip Business Fax No. I hereby certify, under the pains and penalty of perjury, that we have procedures in place to assure compliance with the requirement to return overpayments to MassHealth within 60 days of their receipt pursuant to 130 CMR 450.235 and 450.238. Provider Contact Name (please print) Signature of Authorized Person Completing Form Title Date Member Name RID TCN Dates of Service Credit Balance Reason continued on back u CBR-1 (12/07) Member Name RID TCN Dates of Service Credit Balance Reason