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Upcoming MassHealth Overpayment Notices

November 26, 2018

In the coming weeks, providers may receive initial notices of overpayment from MassHealth. Please note, the findings identified in these notices are preliminary in nature. Providers may dispute overpayments identified in an initial notice of overpayment. If a provider wishes to dispute an initial notice of overpayment, they must reply in writing to MassHealth, and MassHealth must receive such reply within 30 calendar days of the date of the Notice. The written dispute must specifically identify and address all allegations in the Notice with which the provider disagrees, and explain any objection to the identified overpayment. With the reply, the provider may also submit additional data and rationale to support its claim that the provider was not overpaid or out of compliance with the applicable regulations, and must include any documentary evidence it wants MassHealth to consider with respect to the identified overpayment. The initial notice of overpayment will provide the provider with the appropriate contact to send written disputes and any other questions.

MassHealth will consider and review only information submitted within a timely reply. If a provider requires additional time to compile documentation they wish to include with their timely reply, they may reach out to the contact provided on their initial notice of overpayment to request an extension. If, after reviewing the reply, MassHealth determines that the provider was overpaid or was out of compliance, it will notify the provider in writing of its final determination, which will state the amount of any overpayment. The final determination notice will also contain information about the provider's right to an adjudicatory hearing.

If you have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or email providersupport@mahealth.net.