Claims Payment Systemic Error

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.

The linked monthly reports below are Molina’s required communication. 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.

Links below are in PDF Format (icon PDF)

 

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