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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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…

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Please find Arizona Telehealth policies and breakout of audio only, audio and visual combined, etc. referenced by Dr. Megan Woods during her discussion:

https://www.azahcccs.gov/AHCCCS/Initiatives/Telehealth/

Hi @kari-engelkewisconsin-gov

Happy to share what we outline in our policies. Trying to keep it somewhat high level here but happy to discuss further if needed.

Let me link and share a few things:

• ACOM 103 (

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Here in AZ we use TLO, Asset Verification, Skip tracing, etc. Not sure if this is the type of information you were looking for.