We've recently been told that (a) states have eight quarters from a claim's date of service to claim federal matching funds (FFP); and (b) the clock restarts if the state retracts a claim. I am trying to confirm the accuracy of these two statements and would appreciate hearing from anyone knowledgeable on this subject. Bonus points for cite!
Maryland is beginning the process to reconcile Optum's estimated payments to providers in 2020 with the claims revenue during the same period. We have $80M in denied claims and up to $60M in potentially missing claims, and we've been having a great deal of trouble getting Optum to make the necessary corrections to get these claims paid. I'm concerned that part of their reluctance may be that Maryland's contract makes Optum responsible for unclaimed federal match and, if the eight quarter limit is accurate, they are now outside that window. If retraction is a viable solution to restart the clock, we may want to evaluate whether we should advocate pursuing that strategy, so I'm trying to confirm the accuracy of what we've been told.
Appreciate any insights this group may have on the accuracy of the 8 quarter and re-starting the clock.
Many thanks,
Shannon Hall
CBH
------------------------------
Shannon Hall
Community Behavioral Health Association of Maryland
Catonsville MD
410-788-1865 ext 2
------------------------------