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MetroPlus has contracted with HMS to help identify other third-party coverage for our Medicaid members. Through the Disallowance process, HMS has identified where MetroPlus has paid a provider for a claim(s), but another payer is liable. In this recovery project, HMS will notify the provider that the claim has been paid incorrectly and request that the provider bill the appropriate entity. HMS will supply the provider with a notification letter, claim audit details, as well as a window to bill the liable payer and receive the recovery. At the end of the notification period, MetroPlus will retract the Medicaid payments for the claim(s) that have been identified. In several instances, the provider may receive a higher reimbursement from the other carrier than they would have if Medicaid paid. Read press release>>

last updated: January 1, 2019

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