Claims Payment Systemic Errors

Effective for dates of service on and after July 1, 2018, Ohio Managed Care Plans are required by the Medicaid Managed Care Provider Agreement (Appendix C, Claims Payment Systemic Errors), to communicate to providers when claims adjustments are processed for incorrectly underpaying, overpaying or denying claims when certain criteria is met. Cases that meet these criteria are defined as Claims Payment Systemic Errors, or CPSEs.

Effective 2021, Molina posts 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 contact Molina Provider Services at (855) 322-4079 or reach out to your Provider Services Representative.

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