Reimbursement Denials

By January 27, 2022April 27th, 2022No Comments

Are Reimbursement Denials reducing your income?

Are you checking Reimbursement Denied Reports every Monday afternoon? It is important to do so in order to maximize your revenue. Here are some important things to know:

  • Reimbursement Denied Reports can be viewed online in the Medicaid Billing System (eMBS) under Provider Weekly Reports.
  • There are over 10 different reasons for denials. Here are a few:
    • Recipient was not Eligible on Date of Service
    • Recipient Eligibility
    • Provider Listed as Inactive in Medicaid Information Technology System (MITS)
    • Duplicate Claim
    • Claim Exceeds 365-Day Filing Limit
    • Staff and/or Group Size Invalid
    • 3rd Party Liability
  • Claims identified on a Reimbursement Denied Report must be corrected and resubmitted to the Department of Developmental Disabilities (DODD) before the claims can be submitted to the Ohio Department of Medicaid (ODM) for payment approval.
  • The DODD submits all I/O, LV1 and SELF waiver claims to ODM for final approval or denial through MITS. Any claim denied by ODM cannot be paid by DODD.

Denials can be related to ineligibility. We’ve seen an example recently of individuals not completing their Medicaid re-determination accurately or on time, and providers losing revenue.

On behalf of MBS’ provider-clients, we check for Reimbursement Denied Reports weekly, research any issues, work with the appropriate parties to correct, then resubmit for