The Department of Health Care Services (DHCS) is finalizing efforts to implement a systematic solution to Medi-Cal claim overpayments made to Long Term Care (LTC) providers. Overpayments were made due to provider billing software that erroneously dropped the Medi-Cal recipient’s Share of Cost (SOC) from the claims submitted for payment via Computer Media Claim (CMC), for dates of service January 1, 2004 through March 23, 2007. The DHCS plans to recoup these overpayments from providers.

To systematically identify the pool of affected claims, DHCS needs the cooperation of providers. Affected providers, (those who submitted LTC claims for dates of service January 1, 2004 through March 23, 2007) must report to DHCS the SOC amount that should have been reported on the original LTC claim(s).

The decision in Johnson v Rank prevents DHCS from assuming Medi-Cal claim(s) were submitted incorrectly. Claims with no reported SOC will not be assumed to be in error.

DHCS will use this SOC information to complete an automated Erroneous Payment Correction (EPC). In order to identify the affected claim(s), DHCS will need the exact SOC amount that should have been reported on the LTC claim(s) from the dates of service January 1, 2004 through March 23, 2007, along with the following additional information:

• Provider Number
• Provider Name
• Claim Control Number (CCN)
• SOC Amount

If the CCN is not available, the following information will be needed based from the original claim:

• Provider Number
• Provider Name
• Recipient ID
• Dates of Service From – Through
• SOC Amount

DHCS can accept the information in MS Word, MS Excel or in text file format.

	Template	Format
		MS Word	MS Excel	plain text
	Including CCN
	No CCN

The information may be submitted in hardcopy form or on a password-protected compact disc (CD) using WinZip to “zip” (compress) the files.

Instructions on how to zip and encrypt files using WinZip

1. Create the document(s) you would like to zip.

2. Save the file(s).

3. Open WinZip.

4. Create a new archive file.

5. Add the file(s) to WinZip.

6. Select the option to encrypt.

7. If a WinZip caution dialog box appears, click OK.

8. Enter your password. (verify that “Mask password” has been selected)

9. Re-enter your password for verification.

10. Select the encryption method.

11. Click OK.

12. Burn the encrypted file to a CD.

 

When selecting a password for encryption, please follow these security guidelines:

• Use a minimum of eight characters.
• Do not include any recognizable words within the password.
• Use at least one non-alphabet character (number, dashes, etc.).
• Use at least one character from the alphabet.

Please include the contact name and phone number of the person who will relay the password, as it should not be included with the CD. Send the CD to:

EDS Attention: Correspondence Specialist Unit P.O. Box 13029 Sacramento, CA 95813-4029

Once the data is received, it will be matched to the original claim(s) to determine what adjustments to the prior payments are needed. When claim amounts are adjusted, providers with overpayments will be notified and will have the opportunity to dispute the overpaid amount and request repayment arrangements. DHCS plans to allow for a 120 day window from the publication date of this bulletin for providers to submit the requested information to the address above.

Questions concerning this process may be directed to the Telephone Service Center (TSC) at 1-800-541-5555.