MSA Finalizes Policy to Use Medicaid Health Plan Encounter Data from CHAMPS

Posted on September 08, 2017

The Medical Services Administration (MSA) recently released a final policy describing changes to the way Medicaid reconciliation report settlements are processed for federally qualified health centers and rural health clinics. The MSA will begin using Medicaid health plan (MHP) encounter data from the Community Health Automated Medicaid Processing System (CHAMPS) for these facilities, effective with dates of service on and after Oct. 1, 2016. Use of this data will eliminate the need for providers to submit a health plan detail file. Clinic providers will continue to be required to file capitation schedules with the monthly totals of payments received from each MHP.

Featured in the MHA Monday Report. Click to view the full edition.The final policy requires MHPs to ensure that encounter data is complete and accurate for purposes of the clinic settlement process. It is the provider’s responsibility to meet the claim submission requirement specified by each MHP. Providers should attempt to resolve any issues or discrepancies with the individual MHP and contact their hospital and clinic reimbursement division (HCRD) auditor for additional assistance or with other questions regarding the reconciliation report. The HCRD retains the ability to issue revised settlements following resolution of encounter data disputes. This policy does not modify or remove providers’ appeal rights. Members with questions should contact Vickie Kunz at the MHA. 

Tags: reconciliation, MSA, CHAMPS, MHP

Posted in: Member News

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