Notice of Capitation Takeback Project

04/29/2025

Dear Provider,

Meridian is notifying providers of an ongoing Capitation Takeback Claim Recoupment project in accordance with Michigan Department of Health and Human Services (MDHHS) policy.

MDHHS conducts monthly capitation takebacks for members who lose eligibility with Meridian. These takebacks can occur at any time – there is no time limit on how far back MDHHS can retroactively adjust eligibility and recover capitation payments.

As part of this process, Meridian is required to conduct a claims review for impacted members and recoup any previously paid claims from providers.

Claims identified in this review will reset and denied with EX code 28 (Member not eligible on date of service).