Section He-W 521.07 - Adjustments to Payments(a) In response to all payment errors identified by the department, MCO, MFCU, CMS, U.S. Department of Health and Human Services Office of Inspector General (OIG), providers, or other reviewers, the provider shall repay medicaid or MCO, either through direct payment or recoupment, the total amount of overpayment identified. Payment errors may include incorrect claim submissions, payments in excess of the amount allowed, and fraudulently claimed payments identified.(b) An adjustment to a payment may be requested by a provider when a claim for payment was billed in error, the bill was incorrect, or overpayment was detected.(c) The provider shall submit a written request to the department's fiscal agent for fee-for-service claims or the MCO for managed care claims for an adjustment or recoupment.(d) The department's fiscal agent or MCO shall process the adjustment and make any additional payment as necessary or recoup over payments from future claims.N.H. Admin. Code § He-W 521.07
Derived from Number 10, Filed March 7, 2024, Proposed by #13884, Effective 2/22/2024, Expires 2/22/2034 (See Revision Note at chapter heading for He-W 500) (See also part heading for He-W 521).