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Elizabeth M. Whitehorn, Director

Co-payment Deducted Twice for Reimbursement Amount

HFS System Issue:

Some encounter claims from Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), and Encounter Rate Clinics (ERCs) had a co-payment deducted twice from the reimbursement amount.

Problem:

Copay indicators were not being reset between claims, causing some claims to have two co-pays deducted.  Double co-payments will be displayed on the paper remittance advice.

Providers Impacted:

FQHCs, RHCs, and ERCs

Procedure Codes Impacted:

T1015 when one of the detail codes had a co-payment liability.    

Problem Begin Date:

November 2015

Problem Fix Date:

December 4, 2015

Resolution for Impacted Claims:

In order to receive the co-payment amount that was deducted inappropriately, providers must submit a replacement claim if two co-payments were deducted from the reimbursement amount.  The replacement claim should include the encounter code (T1015) on the first service section and all detail codes from the original paid claim.
The Department will accept replacement transactions submitted through MEDI or via 837P files if submitted within 12 months from the original paid voucher date.  To replace a claim, enter Claim Frequency “7”.
Detailed instructions on how to replace a claim electronically can be found in the Chapter 300,
837P Companion Guide
.