Recoupment of Paid Claims with No Eligibility or Capitation

Dear Providers,

As part of our ongoing commitment to compliance and claims accuracy, we are initiating a monthly project to recoup all paid Medicaid claims for which members had no eligibility or capitation at the time of service.

What You Need to Know:

• This applies to Medicaid claims where capitation or eligibility was not present.
• These recoupments will occur monthly, similar to previously established capitation takebacks.
• Impacted specialties: Multiple
• Status: In Progress
• Estimated Completion: To Be Determined

Next Steps: No action is required on your part at this time. If you believe a claim was recouped in error, please follow the standard dispute process outlined in your provider manual. We appreciate your attention to this notice and your continued partnership in ensuring claims accuracy.