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Elizabeth M. Whitehorn, Director

Recoupment of Affordable Care Act (ACA) Primary Care Increased Payments

Problem:

The Department applied an increased payment rate to practitioners for primary care services for participants who are enrolled in Title XXI or state-funded programs in error. Only services to participants enrolled in Title XIX programs are eligible for the enhanced payment.

Providers Impacted:

This issue impacts Providers who have attested to eligibility for the increased payments for Primary Care Services available under the Affordable Care Act (ACA).

Procedure Codes Impacted:

Not Applicable

Problem Begin Date:

January 1, 2013

Problem Fix Date:

November 18, 2013

Resolution for Impacted Claims:

The Department is processing adjustments to recoup the erroneous additional payments. On March 10, 2014 the Department began issuing remittance advices identifying the erroneous payments with an Adjustment Reason Code 3317, which indicates an ACA Pmt Recoup/Client Category Ineligible. ACA PCP enhanced payment adjustments are paid on separate vouchers from other claims. The adjustments identified will be applied on the next available voucher for ACA payments. This will continue until all payments are recouped. The department will not recoup against any other type of payment.