Complete Story
IMMEDIATE ACTION NEEDED TO ENSURE YOU RECEIVE PAYMENT!
OVER 13,000 MEDICAID CLAIMS, FROM OCTOBER 1 AND 2, MUST BE REBILLED OR YOU COULD LOSE YOUR MONEY!
October 1 and 2, over 63,000 claims worth millions of dollars, were improperly billed to the state fee-for-service program, instead of to the new managed care entities, because the system did not reject these claims.
The State has determined that these claims need to be reversed and rebilled, by the pharmacy, to the correct MCO. In order to expedite this process the State has requested that ACS make available to every pharmacy a spread sheet that contains all relevant information needed to rebill the claims correctly.
If you have not yet been contacted by ACS, you must IMMEDIATELY send an email to ed.jingluski@acs-inc.com requesting the spreadsheet listing all claims that were improperly billed to fee for service instead of managed care on Saturday and Sunday, October 1 and 2. The state's processor will send you an Excel spreadsheet showing all needed information to rebill these claims. Our understanding is that you will need to reverse the claim from the state, then rebill it. Some of these claims will hit the formulary of the MCO and be rejected. The state has indicated, since they caused the problem, that they will pay the claim after that rejection. However, you need to know what claims are a problem, and get them rebilled to get your money. OUR PRIMARY CONCERN RIGHT NOW IS FOR YOU TO GET YOUR MONEY!
Let's be clear. OPA has made it clear to all parties, going up to the Governor's office, that this situation is inexcusable, and should have been handled differently. However, the most important need is for you to quickly determine the extent of the issue for your pharmacy, and take action.
OPA has been actively working to straighten out the mess that the changeover to Medicaid managed care caused early in October. You may be unaware that these claims are a problem, so be sure to request your spreadsheet, so you know exactly what you are dealing with!
In this note, we won't detail the dozens of meetings, phone calls, emails and other communications we've had on your behalf on this issue. Because now we need you to protect your financial interest, please get the information, and take action. The good news in this mess is that you can get a list of the problems, and all the information you'll need to rebill. Let us know any problems you encounter as you rebill. Just do it NOW.....
