Provider Update: July 18, 2019

To:                   ADvantage Case Management, Home Care, Adult Day Health, Assisted Living, and State Plan Personal Care Providers

Subject:          Fiscal Year 2020 Claims Adjustment

The Medicaid Services Unit has received correspondence from DHS advising of a one-time claims adjustment for the three months of FY2020 not included in the legislatively mandated rate increase submitted to CMS for a proposed begin date of 10/1/2019.

Included with this bulletin you will find detailed instructions on how the claims adjustment process will be managed. 

Please see the letter immediately below.

Dear Provider,

This past year, OKDHS received funding to increase certain rates for your programs and the Department has moved forward as quickly as possible with required processes in order to implement them. However, despite best efforts, it appears we will not have CMS approval on the required state plan and waiver amendments in order to implement the new rates in the MMIS claims system until at least 10/1.

However, OKDHS is committed to ensuring that you have the resources necessary to provide the needed services to our customers. Because of this, we will utilize state funds to do a one-time retro-payment for all claims submitted with dates of service between 7/1/19 and 9/30/19 in order for you to realize the rate increase for the entire SFY2020.

To do this, OKDHS/OHCA staff will run a utilization report on 10/31/2019 and for all claims paid during the specified time period, will provide a remit in an amount that equals the difference between the amount paid and the new rate that was approved through rates and standards hearings and that we expect to receive federal approval for. 

However, we will only utilize internal resources to do one claims cycle for the adjustment, so it is important that you file clean claims timely and have all of your 7/1 – 9/30 claims submitted by October 15, 2019. Claims submitted after 10/15 with dates of service between 7/1 – 9/30 will not be considered for the adjustment.

We appreciate all that you do for Oklahoma's most in need.