Medicaid Credit Balance Amnesty Review
The South Carolina Department of Health and Human Services (SCDHHS) has a contract with Health Management Systems, Inc. (HMS) to act as the agency’s recovery audit contractor (RAC), pursuant to the federal RAC audit requirements. As a part of the RAC services provided, HMS was to conduct credit balance audits of Medicaid overpayment transactions of South Carolina Healthy Connections Medicaid-enrolled providers.
As part of these credit balance audits, many Healthy Connections Medicaid-enrolled providers were notified by letter and were requested to review their records of open patient accounts to identify credit balances and overpayments owed to SCDHHS and report those overpayments to HMS.
Healthy Connections Medicaid-enrolled providers are already satisfying the completion of self-reporting credit balance audits and returning these funds directly to SCDHHS and therefore are no longer obligated to comply with the previous credit balance audit request(s) from HMS. However, providers are still required to regularly review their financial records independently to determine if overpayments exist for Medicaid claims and to promptly refund any identified overpayments to SCDHHS.
The remaining portions of the RAC contract are still in effect, which include clinical claims reviews and payment analytic claims reviews. All Healthy Connections Medicaid-enrolled providers are required to respond to requests made by HMS.
Additional resources related to the RAC program are available on SCDHHS’ website. Providers should direct any questions regarding payment analytics and clinical claim reviews to HMS Provider Relations at 866-376-2319 from 9 a.m. - 8 p.m. EST, Monday through Friday.