Medicaid Payment Notice: And Not a Moment Too Soon- Medicaid to Mass Adjust for Medicaid Rates

Hewlett Packard Enterprise (HPE) will perform a mass reprocessing of the impacted FFS physicians and physician extenders’ claims for dates of service July 1, 2015- June 30, 2016. Practitioners that previously attested to the initial ACA PCP rate increase between January 1, 2013 through December 31, 2014 should not resubmit any new day claims on or after July 1, 2016. All claims that paid at the old rate will be reprocessed in the Mass Adjustment. The Mass Adjustment is scheduled to be completed by July 31, 2016.

The Care Management Organizations (CMOs) have already reimbursed these new HB 76 PCP rate increases to their network providers into their capitation rates effective July 1, 2015. Thank you for your patience during the FFS implementation and mass adjustment process of the new HB 76 PCP rate increase for SFY 2016.