Patient Pay Changes Now in Effect; Provider Resources Available

You may recall that the Department of Medical Assistance Services (DMAS) had planned to implement an automated patient pay reduction against claims utilizing patient pay information already on file in the Medicaid Management Information System (MMIS) from the local Departments of Social Services (LDSS).  Originally, this was to be effective April 1, 2015, but was delayed until October 1, 2015.
See the Medicaid memo which outlines the changes.  When claims are priced, the MMIS will utilize the official patient pay determined by the LDSS.  Patient pay will be deducted on a first in first out date of adjudication basis each month; the MMIS will track patient pay “utilization” for every month.  As such, multiple providers may be responsible for patient pay, depending on amounts billed and timing of claims.  Additionally, the MMIS will generate a monthly “discrepancy report” to identify any retroactive patient pay changes for which manual claim adjustments should be made.

DMAS has made available a training presentation and has announced two Q & A sessions for providers on October 27 - registration instructions are available here.