- (1) Providers must identify and report any overpayments within three years of the service date. Accordingly, providers or their contractors must complete self-audits of claims and submit claim corrections within three years of the service end date.
- (2) Providers are responsible for their claim adjustments. Providers must attempt to make adjustments on their own before requesting Medicaid staff to make claim corrections. If a claim is in a suspended status, Medicaid will assign a worker to process the claim according to the policy for the edit.
- (3) Providers identifying overpayments beyond the deadline noted in Subsection (1) must contact the Office of the Inspector General of Medicaid Services to resolve the overpayment.
KEY: Medicaid
Date of Last Change: November 10, 2023
Authorizing, and Implemented or Interpreted Law: 26B-1-204; 26B-1-213; 26B-3-108