Business Process Details - Manage Provider Recoupment
Guidance for the Manage Provider Recoupment business processthat manages the determination and recovery of overpayments to providers. The State Medicaid Agency (SMA) initiates provider recoupment upon the discovery of an overpayment, for example, as the result of a provider utilization review audit, receipt of a claims adjustment request, or for situations where provider owes monies to the SMA due to fraud or abuse.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 01, 2012
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