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Elizabeth M. Whitehorn, Director

Overpayment of Transportation Claims

HFS System Issue:

Update January 21, 2015 - Overpayment of Transportation Claims (A0120, A0130, A0422, A0426, AO428 and T2005) 

Problem:

Transportation claims received by the Department between 12/04/2012 and 03/04/2013 were potentially overpaid to providers.

The quantity billed for the units/mileage codes overwrote the units associated with the “trip” code. The system multiplied the quantity of the billed units/mileage codes by the provider rates and paid the lower of the provider’s charge or the Department’s maximum allowable rate based on units billed multiplied by provider rate for the “trip” code.

Providers Impacted:

Transportation providers who submitted claims received by the Department between 12/04/2012 and 03/04/2013.

Procedure Codes Impacted:

HCPC Codes – A0120, A0130, A0422, A0426, A0428, and T2005

Problem Begin Date:

Claims received:  12/04/12

Problem Fix Date:

Claims received:  03/05/13

Resolution for Impacted Claims:

There are approximately18K claims impacted in the amount of $1.8M. The department will process adjustments to recoup the overpayments beginning January 2015 and will be scheduled for each month through June 2015. The adjustments will be spread over six month period to lessen the impact on providers.