July 29,2019: Patient Pay Offset Reminder

July 29, 2019: Attention Institutional Providers:  As a reminder of current MSA policy, outlined in MSA 18-23, when offsetting the patient-pay amount using Value Codes 25, 26, 27, 28, 29, 33, or 34 documentation must accompany the claim.  The documentation requirement is effective for claims with a date of service on and after September 1, 2018.  

The documentation that must accompany the claims include: 

  • the specific reason that the patient-pay amount is being offset;
  • a detailed description of the specific item or service that is offset;
  • and a receipt showing that the beneficiary paid for the Medicaid non-covered service. 

The provider must upload the documentation to the CHAMPS Document Management Portal (DMP) and include a claim note that indicates documents have been uploaded to DMP.  

MDHHS has completed claim recoveries for claims paid without the above-required documentation. Claims adjudicated on or after June 24, 2019, will deny when the above-required document is not submitted.