Credit Balances

What is a credit balance?

 

Credit Balance refers to funds that should be returned to MDHHS because a claim has been paid by another party. They are also referred to as Overpayments.

 

How do I return a credit balance?

A provider will need to void their claim directly in CHAMPS if they need to return the entire amount MDHHS paid. Please refer to the Billing & Reimbursement Chapter of the Medicaid Provider Manual. As a reminder, a void will completely void the original claim in CHAMPS and take back the initial payment.

If the amount a provider needs to return is less than the full amount, a partial adjustment should be performed. Please refer to the Billing & Reimbursement Chapter of the Medicaid Provider Manual.

What happens if I get an error when returning the credit balance?

On rare occasions, a provider may be unable to adjust/void the claim in CHAMPS. If this occurs, please contact Provider Support for assistance at 1-800-292-2550.

Will MDHHS contact me about credit balances?

Do not wait to be contacted. Please void/adjust all claims with credit balances via CHAMPS immediately upon identification. The Affordable Care Act requires providers to report and repay credit balances within 60 days from the date the overpayment was identified or by the date any corresponding cost report was due, whichever is later.

MDHHS is required to audit providers to determine if there are credit balances owed to the state. Providers may be contacted by a vendor on behalf of MDHHS to determine if credit balances exist or by the Office of the Inspector General if those balances have been identified but not repaid.

What should I do if contacted by a vendor?

The vendor will audit a provider’s records to find credit balances. The vendor will compile a report listing claims they have identified as overpayments and share it with the provider. The provider should review the claims, work with the vendor to remove any claims that were misidentified, void/adjust any overpayments due to third party payments, and then approve the report to be sent to MDHHS.