We apologize for the delay in sending this out but we have been waiting for an official comment in writing from CareSource before we sent something out. I have yet to receive this in writing but I just felt you needed to know about the meeting I had with them.
CareSource has admitted to making the mistake. Their system inadvertently went back to October of 2013 to make the changes you were notified about in April of 2014 effective. This means their system went back and looked at all claims since Oct. of 2013 and applied the DX changes and Modifier requirements to all claims. This is why many of you have received overpayment notifications. All of those claims would be viewed as incorrect. This was obviously a mistake. CareSource cannot hold you to a standard you are not aware of. They understand this and are going to fix it.
We had a lengthy conversation on what “Fixing it” looked like and we both agreed that the providers should not have to do anything. CareSource will be doing the following:
• Going in the system to fix the effective date of the changes to April 1, 2014
• They will also grab all of the claims that were deemed “over paid” and see if monies were withheld from current claims.
o If monies were not held they will remove the overpayment request and providers will hear nothing more about this.
o If monies have already been withheld then CareSource will re-issue payment for that amount.
• Provider ARE NOT to resubmit claims. We realize that some of you have called CareSource and they told you to resubmit within 30 days or you would lose the money. THIS IS NOT THE CASE. We also realize some of you may have just called yesterday and talked to someone at CareSource and they gave you different information. We held these meetings with management and it take time to get this information to the front lines.
• CareSource assured me that providers will receive any monies owed within a month and a half.
• The OSCA has already received information that some providers have already gotten their repayment.
As always we are here to help you with these kinds of issues. We thank those providers that reached out to us in the beginning so we could fix this issue. That is the value of having active members in the association. Together we are ALWAYS stronger than on our own.
We will continue to monitor this situation and update you as new information becomes available.
Bharon Hoag - Executive Director
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