Medicaid “Client Responsibility” Errors Subject to Adjustment

ALF/ARC/EARC Contracted Providers Take Note

Yesterday, we received a notification from DSHS regarding the Department’s plan to conduct “mass adjustments” related to address errors in syncing client responsibility amounts with actual payment. We were informed that the Department will be initiating a mass adjustment of claims where paid amounts on the claim do not align with the amount of client responsibility that should have been deducted from the Medicaid claim.

These mass adjustments will affect approximately 250 ALF/ARC/EARC providers with paid claims since April 2023.

For the providers with adjustment(s) resulting in an overpayment their overpayment notice will say the following:

“The amount of client responsibility (CR) applied to your original claim was not correct and you were overpaid by the Department. Review your RA and authorization list to verify CR amounts. If you have questions, email [email protected] and include your provider ID.”

Unfortunately, DSHS only has a list of claims that need to be adjusted and cannot systematically identify those claims that will result in money paid to the provider and which will result in money owed by the provider.

According to DSHS:

• 147 ALF/ARC/EARC providers have 5 or fewer paid claims that need to be adjusted. The only communication we plan to have for these providers is for those where the adjustment results in an overpayment and the claim comment above will be on the overpayment notice.
• There are 37 ALF/ARC/EARC providers that have between 6-10 claims affected.
• There are about 66 ALF/ARC/EARC providers that have more than 10 claims.

We have scheduled a follow-up meeting with the Department on Monday, June 24 for additional detailed information about the impact to providers, and we will keep you updated.