Sequence of Recoupment
Introduction and Background
On October 4, 2021, the Maryland Department of Health (MDH) announced it would begin the process of recouping overpayments made to providers through the Optum Behavioral Health Administrative Services Organization (BHASO) during the “estimated payment” period of January 1, 2020 through August 3, 2020. During this period, MDH directed Optum to make estimated payments to providers based on their average monthly claims payments in 2019 due to issues with processing and paying claims through the BHASO platform.
Next Steps
MDH and Optum understand the challenges that many providers experienced while using the BHASO platform and have been working closely to establish an estimated payment recoupment process that is as fair and flexible as possible. For more details on the sequence of recoupment of overpayments, repayment options, and the forgiveness program established by MDH, please click here to read the Recoupment Sequence provider alert published November 17, 2021.
For providers that received overpayments of estimated claims for the period January 1, 2020, to August 3, 2020, MDH will announce on or about December 1, 2021 the exact dates for beginning the repayment period; check back here for more updates as they become available.
Forgiveness Program
MDH has announced forgiveness of the entire debt for providers that received overpayments of estimated claims for the period January 1, 2020, to August 3, 2020 and owe $10,000 or less (click here for more information). Providers owing $10,000 or less will be eligible for the forgiveness program except for the following categories:
- Hospitals
- Laboratories
- Somatic behavioral health providers
- Out-of-state providers, and
- Providers who have not yet submitted claims against any of the estimated claims paid.
For providers with outstanding or fully paid balances of between $10,001 and $50,000, MDH will engage the provider community and will evaluate providing additional relief.
Repayment Plans
Providers that received overpayments of estimated claims for the period January 1, 2020, to August 3, 2020 and owe more than $10,000 will have one of three options for repayment:
1. Payment in full at the time of notice
2. A 12-month, interest-free repayment plan, or
3. The option to credit current claims paid to offset all or some of the balances owed over a 12-month period, with final payment of any remaining amounts owed to be made at the end of the 12-month period.
Assistance
For assistance with reconciliation at any time, we encourage providers to engage with an Optum Reconciliation Manager by sending an email to maryland.provpymt@optum.com. Please visit maryland.optum.com for provider resources, online training, and more information.