Wiki Medi-Cal Corrected claims

[gwhitley@myinnovage.com]

Hey smart people, Im trying to find documentation on corrected claims and if a Plan can change a Providers billed charges so the claim will pay higher than the original billed charges ie.. a SNF bills 250.00/day and the current fee schedule pays $250.00/day. The state issues a rate change and the provider can now receive $260.00/day for the previous billed claim. Does the provider have to submit a corrected claim refecting the $260.00 or does the plan have responsibility to reprocess without a correction. I think this is a charge master issue with the provider and they should increase their billed charges so that when adjusts are received they wouldn't have to submit corrected claims. Looking forward to your input/feedback. thanks!

 

[SharonCollachi]

An insurance plan will not pay more than you billed. The plan doesn't need to reprocess anything because they paid correctly. It's on you if you didn't bill enough.

All charges should be more than the allowable amount to avoid exactly what you are describing.