Member Vanessa Templeman
Member-
Vanessa Templeman replied to the discussion Administrative terminations for criminal acts not involving Medicaid in the forum State Only Forum a year ago
Reply to Administrative terminations for criminal acts not involving Medicaid
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…
-
Vanessa Templeman posted an update 2 years ago
Anyone familiar and/or have contracts with the company Office Ally?
-
Vanessa Templeman posted an update 2 years ago
AZ is looking for best practices concerning the prioritization of cases for investigation? Please share what you find works and what hasn’t previously worked. Thank you!
-
Vanessa Templeman replied to the discussion UPIC Final Findings Report (FFR) in the forum State Only Forum 2 years ago
Reply to UPIC Final Findings Report (FFR)
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…
-
Vanessa Templeman replied to the discussion Referrals to MFCU in the forum State Only Forum 2 years ago
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 replied to the discussion Overpayment Demand Letter Template/Format in the forum State Only Forum 2 years ago
Reply to Overpayment Demand Letter Template/Format
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:
-
Vanessa Templeman replied to the discussion Balance Billing in the forum State Only Forum 2 years ago
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.
-
Vanessa Templeman replied to the discussion Balance Billing in the forum State Only Forum 2 years ago
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…
-
Vanessa Templeman replied to the discussion Provider Self Audit Resources in the forum State Only Forum 2 years ago
Reply to Provider Self Audit Resources
Here is some language from our template letter in AZ:
……. uses data analytics to identify unusual billing patterns among providers within the same specialty and geographic area.
The attached claims/encounters data, submitted under your provider ID, revealed an unusual pattern of billing that may have resulted in an overpayment. You…
-
Vanessa Templeman replied to the discussion Unraveling Telehealth in Behavioral Health Webinar Discussion in the forum Open Forum 2 years ago
Reply to Unraveling Telehealth in Behavioral Health Webinar Discussion
Please find Arizona Telehealth policies and breakout of audio only, audio and visual combined, etc. referenced by Dr. Megan Woods during her discussion:
- Load More
