Claims Payment Systemic Errors

Ohio Managed Care Plans are required by the Medicaid Managed Care Provider Agreement (Appendix K, Claims Payment Systemic Errors) and the MyCare Ohio Provider Agreement (Appendix C, Plan Responsibilities) to communicate to providers when claims adjustments are processed for incorrectly underpaying, overpaying, or denying claims when certain criteria are met. Cases that meet these criteria are defined as Claims Payment Systemic Errors, or CPSEs.

  • Starting Feb. 1, 2023, as part of the Next Generation Medicaid Program, Molina will post a linked monthly report below to meet this requirement.
  • Prior to Feb. 1, 2023, Molina will continue to post a linked bi-monthly report below to meet this requirement.

All prior monthly reports are archived on this site. If you have any questions after reviewing these reports, please reach out to your Provider Services Representative.

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