Credit Balance Recovery

Tagged: 

 

The South Carolina Department of Health & Human Services (SCDHHS) is continuing its Credit Balance Review project. We have enlisted our Medicaid Insurance Verification Services (MIVS) contractor, Blue Cross Blue Shield of South Carolina (BCBSSC), to carry out this initiative.  A Credit Balance is a positive amount that remains in a patient’s account which may have resulted from multiple reimbursements from several payers, adjustments to previously paid claims of a provider, duplicate payment, or subrogation events due to accidents and other injury cases. When another third party payer reimburses a provider for claims that Medicaid paid, either in part or in full, a refund is due to the Medicaid Program.  The Medicaid agency must take all reasonable measures to ascertain the legal liability of third parties to pay for care and services available under the state Medicaid plan.  A Credit Balance review is one of many methods that assist the agency in meeting this obligation. 

The intent of this review is not to supplant the efforts of routine health insurance recoveries through normal cost avoidance methods and restricted retroactive look-backs. Providers should continue to address retro Health and retro Medicare initiatives timely throughout all months. The aim is to address processes and/or procedures that may lead to the occurrence of a credit balance, and to provide education and monitoring for program adherence.

The approach of our contractor is to request quarterly credit balance certification and claim level detail, a process similar to that in place for Medicare providers.  Attached are copies of the Medicaid Credit Balance Report Certification Page, the Medicaid Credit Balance Report – Claim Detail, and a sample reminder letter that will be sent to providers who do not submit credit balance reports within thirty (30) days of the end of the quarter.

October 31, 2012 is the due date for the first credit balance reports under the BCBSSC contract for MIVS.  The report may update previously unreported credit balances and should cover the period of July 1 through September 30, 2012.  The reports and checks may be mailed regular or certified mail to MIVS, Attn: Benefit Recovery – Credit Balance Reporting, P.O. Box 8355, Columbia, SC 29202-8355 or may be sent by facsimile to MIVS, Attn: Benefit Recovery – Credit Balance Reporting, 803-462-2582.  Written requests for debit adjustments may be submitted in lieu of a check.

The provider outreach staff of BCBSSC will provide upcoming training opportunities that will be announced by future bulletins.  In advance of the training, providers may submit sample questions by e-mail to assist the trainers in identifying the areas of primary interest to providers.  The appropriate e-mail address is creditbalancemivs@bcbssc.com

If you have any questions regarding this bulletin, please contact Third Party Liability at (803) 898-2907.  Thanks for your continued support of the South Carolina Medicaid Program.

Report Fraud