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Audits of payments for Non-Medicaid services will occur on an ongoing basis. BHSD has set the following rules in place to audit claims paid through non-Medicaid funds. The recoupment details are intended to assist providers on in how to appropriately bill non-Medicaid funding.
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Vendors and Lead Agencies can go back - and - forth between 'Clarification Required' and 'Clarification Provided' as many times as necessary. The Lead Agency can also choose at any time to 'force' a recoupment.
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Click the QA Review drop-down.
Click Boxing Ring.
Records flagged for QA review are displayed grouped by Reason with the closest to the auto-recoupment deadline on top.
Click a record to see details in the Record Status, Record Details, and Record History sections. (Clicking the record will also mark it as Read when clicked for the first time)
Click the ^ icon of each section to expand/hide the section as needed.
Enter data in the search criteria fields on the top of the screen to search for specific records.
(INSERT UPDATED SCREENSHOT OF BOXING RING)
Record Icon Definitions
Icon | Definition |
| Record has been flagged for Recoupment by the Lead Agency |
| Pending Vendor Notification by the Lead Agency |
| Clarification to Petition has been provided to the Lead Agency by the Vendor |
| Clarification to Petition Requested by the Lead Agency |
| Recoupment has been Confirmed by the Vendor |
 | Recoupment has been Abandoned by the Lead Agency |
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Vendors have 7 days to Accept or Petition to for Records marked for Recoupment. If they do not Accept or Petition within the 7 days the system will auto-recoup the records.
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The Record Status section for each Record will display the # of days remaining in the 7-day count-downcountdown.
Read/Unread Record(s) marked for Recoupment
Click the Record(s) in the Envelope column to highlight and mark it as Read or Unread.
Accept Record(s) marked for Recoupment
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Click the Record(s) in the Checkmark column to highlight.
Click Submit Clarification.
Click the Detailed response to clarification request field and enter information.
Click the file upload field or drag and drop to add supporting documents. (To delete an attachment click the trach trash can icon next to the document)
Click Submit to confirm the clarification.
The status icon for the record(s) will change from a ? to a P.
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