Overpayment Recovery. The CHC-MCO shall audit, review and investigate Providers within its Network. The CHC-MCO shall recover any overpayments directly from its Network Providers for audits, reviews or investigations conducted solely by the CHC-MCO. o The CHC-MCO will void Encounters for those claims involving full recovery of the payment and adjust Encounters for partial recoveries. o The CHC-MCO must report all voids and adjustments to Encounters to the Department • The Department may audit, review and investigate MA Providers within the CHC-MCO’s Network. o The Department will develop a process to coordinate audits, reviews or investigations of Network Providers to avoid duplication of effort.
Appears in 2 contracts
Sources: Community Healthchoices Agreement, Community Healthchoices Agreement