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Response to RFP No. MED13002 State of West Virginia ... - DHHR

Response to RFP No. MED13002 State of West Virginia ... - DHHR

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No Findings Sample NO FINDINGS LETTER West Virginia Bureau for Medicaid Services xxxxxxxxxxxx xxxxxxxxxxxxxxxx x-xxx-xxx-xxxx Notification Date: MM/DD/YYYY Provider Name: Provider Attn: Contact Name or Business Department Provider Address City, State ZIP Subject: No Findings Client Name: ICN #: Date of Birth: Medical Record #: PCN #: Date of Service: Case ID: Concept Short Name: Last Name, First Name MM/DD/YYYY MM/DD/YYYY to MM/DD/YYYY Dear Contact Name or Business Department: We have completed a review of your payment data and medical records. There were no negative findings under the XXXXXXX No further action on your part is required. If you have any questions, please contact the West Virginia Bureau for Medicaid Services Audit at x-xxx-xxx-xxxx. Please be advised that West Virginia Medicaid conducts periodic reviews of the accuracy and appropriateness of billing, payment, and treatment. The claims at issue here are still subject to future periodic reviews by the West Virginia Bureau for Medicaid or its designee. If you are selected for another review, you will be notified separately.

Demand Letter Sample West Virginia Bureau For Medicaid Services XXXXXXXXX XXXX X-XXX-XXX-XXXX Notification Date: MM/DD/YYYY Provider Name: Provider TPI Attn: Provider Address City, State ZIP Subject: Demand Letter Client Name: ICN #: Date of Birth: Medical Record #: PCN #: Date of Service: Case ID: Concept Short Name: Last Name, First Name MM/DD/YYYY MM/DD/YYYY to MM/DD/YYYY Dear Director of Health Information Management: This letter is to notify you that West Virginia Medicaid has made an (overpayment/underpayment) to you for the amount of $xxxxx. A brief description of the claims associated with this FINDING can be found on the "Overpayment/Underpayment Report" page. Our findings letter dated x/xx/xxxx provided the detailed reason(s) for the overpayment/underpayment determination. In order to correct this overpayment/underpayment, please refund $xxxxx by x\xx\xxxx. Our request for additional medical documentation, detailed in a letter dated x/xx/xxxx, constituted reopening under §1869(b) (1) (G) of the Social Security Act and 42 CFR 405.980(a) (1). Our good cause to reopen the claim, if required by 42 CFR 405.980(b) (2), was described in the letter as well. Please make the check payable to Medicaid and send it with a copy of this letter and the Overpayment Report containing the specific claim and accounts receivable information to the following address. Please indicate the Accounts Receivable number(s) that you are paying with this check. xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxxxxxxxxx THE REMAINDER OF OUR DEMAND LETTERS TYPICALLY HAVE INFORMATION ON THE FOLLOWING TOPICS: Key Timeframes How to Stop Recoupment What are the timeframes to stop recoupment What happens following a reconsideration by a Qualified Independent Contractor

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