[BREAKING]
– FLORIDA
ACHA has requested Xerox State Healthcare, LLC to do a
POSTPAYMENT Audit on all Florida Medicaid Providers. The letter is being sent
in batches to the providers requesting a review of payment from :
10/2012 to 05/2014.
According to the ACHA, they have issued overpayments on the E/M Codes.
Furthermore, the letter reads:
Xerox State Healthcare, LLC
P.O. Box 13979
Tallahassee, FL 32317
xerox
June 20, 2014
Dear Medicaid Provider:
The Florida Agency for Health
Care Administration (AHCA) has contracted with Xerox
State Healthcare, LLC to review
provider records for overpayments involving Medicaid
accounts. When a third party
reimburses a provider for claims that Medicaid paid in part
or in full or when Medicaid
makes payment in excess of its liability, a refund may be due
the Medicaid program. In
accordance with page 5-9 of the Florida Medicaid Provider
General Handbook regarding
self-audits, we are requesting that you promptly review
your records, excluding
Outpatient Medicare Part B Crossover claims, on which you
received Medicaid payments
between October
2012 thru May 2014 to
identify any
overpayments that are owed to the
Florida Medicaid Program. Please follow the
instructions below to correct
these accounts and refund
the
appropriate amounts to
Florida Medicaid within thirty
(30) days of the date of this notice.
Section 1902 (a) (25) of the
Social Security Act provides that the State agency
administering the Medicaid
program will take all reasonable measures to determine the
legal liability of third parties
to pay for care and services arising from injury, disease or
disability. Pursuant to Title 42
of the Code of Federal Regulations, Part 433.139 and
authority cited therein, Medicaid
providers are subject to reviews in order to ensure
compliance with State Medicaid
third party liability efforts, other relevant state and
federal regulations, and the provider
agreement with AHCA.
Please note that
this letter only refers to overpayments that have not previously
been identified
by Xerox or AHCA, and have not been previously refunded or
voided through
the MMIS web portal. Outpatient Medicare Part B Crossover
Claims are
exempt from this audit.
STEPS TO REFUND
EXCESS MEDICAID PAYMENTS:
1. Complete the attached
worksheet titled "AGENCY FOR HEALTH CARE
ADMINISTRATION OVERPAYMENT
WORKSHEET" for credit balance
overpayments only. List all
overpaid claim specific and Medicaid beneficiary
information in the spaces
provided. A sample worksheet and instruction page has
been provided to assist in
completing the worksheet. This worksheet should
ONLY be used in
response to this overpayment project. Additional worksheets
may be obtained by photocopying
the enclosed worksheet as necessary or by
calling Xerox at 1-877-357-3268
opt. 3 extension 3967 (toll free) to have a copy
e-mailed to you.
2. Once you have identified all
overpayments made by Medicaid and completed the
appropriate worksheets for each
overpayment, please issue a refund check MADE
PAYABLE TO AGENCY FOR HEALTH CARE
ADMINISTRATION.
3.
Send all refund checks and overpayment worksheets to Xerox at the following
Address
.
Xerox Third Party Liability
Services
P.O. BOX 13979
Tallahassee, FL 32317
Xerox will notify AHCA of all
refunds made through this project. AHCA will update its
paid claims history files for
your facility to ensure that AHCA's payment records for your
facility are accurate. If for any reason you are unable to provide
claim specific
information
please contact Xerox prior to submitting check.
If no refunds
are due AHCA, please indicate this on the worksheet in the space
provided and
return the worksheet to Xerox at the address shown above.
If you have any questions in
relation to this project, please contact Xerox at 1-877-357-
3268; opt. 3 extension 3967.
Thank you for your cooperation in
voluntarily identifying and returning any credit
balances due to Florida Medicaid.
Sincerely,
Ami Vega
Provider Relations Specialist
Xerox
State Healthcare
For more details call
: 305-227-2383 or 1-877-938-9311
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