Introduction and Background
On October 4, 2021, the Maryland Department of Health (MDH) announced it would begin the process of recouping overpayments made to providers through the Optum Behavioral Health Administrative Services Organization (BHASO) during the “estimated payment” period of January 1, 2020 through August 3, 2020. During this period, MDH directed Optum to make estimated payments to providers based on their average monthly claims payments in 2019 due to issues with processing and paying claims through the BHASO platform.
MDH and Optum understand the challenges that many providers experienced while using the BHASO platform and have been working closely to establish an estimated payment recoupment process that is as fair and flexible as possible. Below is initial information on key dates to help providers prepare as MDH and Optum move forward with implementing the recoupment process. This page will continue to serve as a resource for the most up-to-date information.
- No overpayments will be recouped until at least December 2021; in the coming weeks more detailed information on the process and timeline will be posted here and communicated directly to providers.
- Recoupment will not begin until providers have ALL missing or incomplete 835s and PRA reports needed to reconcile their accounts.
- Optum expects to deliver these 835 and PRA reports by October 24, 2021 and providers will then have a minimum of 30 days to review them before agreeing to the amount owed and determining a payment arrangement.
- Optum is continuing to offer one-on-one support to providers in navigating this process. Contact email@example.com to request assistance from a Reconciliation Manager.
Once the review process above is complete, providers will be able to enter into any of the three following payment arrangements:
- Pay the balance owed in full at the time of notice.
- Pay the balance owed in equal, monthly, interest free installments over the course of a 12-month period.
- Offset the balance owed with current claims paid over a 12-month period (not to exceed 12 months).
Forgiveness/Abatement Plan (update to match final JCR language):
In recognition of the challenge caused by repayment, MDH will be forgiving the debt for eligible providers owing $10,000 or less. For providers with outstanding or fully paid balances of between $10,001 and $50,000, we will engage the provider community and will evaluate providing additional relief.
Provider types excepted from participating in the forgiveness process:
- Out of State Providers
- Somatic Non-BH Providers
- Providers who have not submitted any claims against the estimated payments
Upcoming Timeline: What’s Next
- Optum expects to deliver all 835 and PRA reports needed by providers to reconcile their accounts by October 24, 2021.
- Providers will have a minimum of 30 days to review before agreeing to amount owed.
- Recoupment of overpayments will not begin until at least December 2021, after providers have received and had an opportunity to review all missing or incomplete 835s and PRA reports necessary to reconcile their own accounts.
Frequently Asked Questions and Provider Alerts
Provider FAQs and Alerts related to the estimated payments recoupment process will be posted here as they are released.
- Provider FAQ on Recoupment (this FAQ will be updated on an ongoing basis. Please check back regularly for the latest information).