Ohio Code 5167.22 – Recoupment of overpayment
Current as of: 2024 | Check for updates
|
Other versions
When a medicaid managed care organization seeks to recoup an overpayment made to a provider, it shall provide the provider all of the details of the recoupment, including all of the following information:
Terms Used In Ohio Code 5167.22
- Enrollee: means a medicaid recipient who participates in the care management system and enrolls in a medicaid MCO plan. See Ohio Code 5167.01
- Medicaid managed care organization: means a managed care organization under contract with the department of medicaid pursuant to section 5167. See Ohio Code 5167.01
- Provider: means any person or government entity that furnishes services to a medicaid recipient enrolled in a medicaid MCO plan, regardless of whether the person or entity has a provider agreement. See Ohio Code 5167.01
(A) The name, address, and medicaid identification number of the enrollee to whom the services were provided;
(B) The date or dates that the services were provided;
(C) The reason for the recoupment;
(D) The method by which the provider may contest the proposed recoupment.