LDH has identified paid claims associated with administration corrections of member linkages into Bayou Health Plans. These linkage corrections were necessary to ensure compliance with internal policies, approved Medicaid State Plan and maintaining audit controls. Member linkages from February 1, 2012 through June 30, 2014 were evaluated and claims paid by an incorrect entity (CHS, UHC or Molina) have been identified. On August 11, 2014 Molina will systematically void all identified paid claims with a denial reason code 999 Administrative Correction, which will be shown on the Remittance Advice.
In order to rebill, providers must verify the correct entity based on the date of service by using either the Medicaid Eligibility Verification System (MEVS) or the Recipient Eligibility Verification System (REVS). To obtain consideration for payment, providers are required to submit hard copy claims to the correct entity no later than 6 months from the date the claim is voided. If PA or Pre-cert was obtained on the original claim, providers will not be required to obtain additional authorization when submitting these specific prior-paid claims to the correct entity. Documentation must accompany claims verifying the prior payment and void. This documentation of prior payment will also support the authorization of the service. Claims submitted within 6 months of the void date will not be denied based on timely filing.
For this clean-up only, below is a list of affected providers, which includes the provider name, a partial Medicaid Provider ID (to protect privacy), the number of claims, number of recipients and total of payments to be voided. Questions may be sent to Bayou Health via email at firstname.lastname@example.org with the subject line addressed to "Retro Claims".
Beginning September 2014, the process of voiding identified paid claims will be repeated on a monthly basis, to occur around mid-month, for administrative corrections made to member linkages in the prior month.