Hi Dustin,

Every year we send out a call for submissions for the conference. This would be a perfect topic for what you are suggesting. We ask for a variety of presentations and items and this sounds like it would be a great addition!

I’ve already shared with Hawaii but also sharing here:

<font color=”#000000″>We (AZ) house our policy for denials and terminations in the same policy. Based on this discretionary language, if we identify fraud, waste, and abuse concerns, or health and safety concerns when going through the screening process for a provider seeking to enroll, we…

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We were able to get our UPIC to introduce a new step. We have the IFR, introduced the EFR (exit findings report), and FFR won’t be issued until 1)the provider agrees to pay the monies back or 2) a final court finding is issued.

We pushed and purposely designed this so the State wouldn’t be on the hook for monies prior to the judicial processes…

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Hi There! Let me know if you have time to chat and AZ will make time to share our relationship dynamics with our MFCU and how we interact.

vanessa.templeman@azahcccs.gov

Since the provider self identified the overpayment, you may want to consider creating a self disclosure process to incentivize providers to return payments. Here is ours:

https://www.azahcccs.gov/Fraud/Downloads/SelfDisclosure.pdf

We also send out letters to providers advising them of their incorrect balance billing. We’ve had one instance of a provider who refused to reimburse the member so we did issue a Civil Monetary Penalty as a result.

Here is a term we have in our provider contracts that addresses both balance billing and collecting cash in lieu of charging AHCCCS:

The Provider shall not bill, nor attempt to collect payment directly or through a collection agency from a person who is or claims to be AHCCCS eligible without first receiving verification from AHCCCS that the…

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