Medicaid Policy                                                                 

825-6 Referral for Adjudication

Effective Date: October 1, 2010

No Previous Policy

 

After the Benefit Accuracy Analyst calculates an overpayment or understatement of liability, the analyst must decide whether to refer the overpayment for adjudication (DWS section 820).  

1. Do not refer overpayments or understatements of liability resulting from agency errors for adjudication.   Do not try to collect overpayments or understatements of liability resulting from agency errors.

2. Do not refer overpayments or understatements of liability resulting from inadvertent household errors for adjudication when the cumulative amount is $300 or less.  Do not try to collect overpayments or understatements of liability when the cumulative amount is $300 or less.

3. Always refer overpayments or understatements of liability resulting from inadvertent household errors for adjudication when the cumulative amount is more than $300.

4. Refer all overpayments and understatements of liability resulting from SIPV’s for adjudication.