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 202 February 2010 TO: All Providers Participating in MassHealth FROM: Terence G. Dougherty, 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 Fines for Failure to Comply MassHealth may impose administrative fines against providers who do not return overpayments classified as credit balance within 60 days of their receipt, per 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 Administrative Fines From the time you receive this bulletin until March 31, 2010, MassHealth will waive its right to impose administrative fines on credit balances identified and listed on the attached Credit Balance Response Form (CBRF). This amnesty waiver does not apply to any current or previously conducted audit, or any notification of intent to audit, or to any Attorney General Medicaid Fraud Division, Office of the Inspector General or other state or federal agency activities. This amnesty waiver does not apply to any provider who participated in a past amnesty waiver, since prior participation included a certification that they had procedures in place to return overpayments within 60 days. Review Your Records You should review your records to ensure that you have identified all outstanding credit balances. To participate in the amnesty waiver program, report your credit balances on the attached CBRF. This 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. (continued on next page) Review Your Records(cont.) Note: The CBRF will be available online only until the close of business on March 31, 2010. 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 lower right corner. Provider Requirements Providers must: (1) Complete the upper portion of the CBRF with a valid signature to certify compliance procedures, and complete the lower portion with the requested information. (2) If the CBRF exceeds 20 claims, please complete the upper portion of the CBRF with a valid signature to submit compliance procedures and submit an electronic file of the information requested on the lower portion of the CBRF. The file should include the fields, in order, as listed on the CBRF. Acceptable file formats are MS-Excel spreadsheet, MS-Access database, and Text file with comma (“,”) delimiters (CSV). For claims to be systematically voided or adjusted, submit a remittance advice highlighting each claim and amount. MassHealth Processing Do not send a check to MassHealth. For claims that can’t be systematically voided or adjusted, a recoupment account will be set up for the amount of the claim submitted as overpayment. Unless other arrangements have been made, MassHealth will recover 100% of your claims payments until the amount recovered equals the identified credit balance amount. CBRF and Files Submission Send the fully completed CBRF, or if the CBRF exceeds 20 claims, the upper portion of the CBRF with a valid signature and an electronic file postmarked by March 31, 2010, 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/ Member ID ICN/TCN Dates of Service Credit Balance Reason continued on back CBR-1 (01/10) Member Name RID/ Member ID ICN/TCN Dates of Service Credit Balance Reason