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Family and Children's Medicaid MA-3535 RECIPIENT FRAUD AND ABUSE POLICY AND PROCEDURES

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IX. North carolina health choice Overpayments

REVISED 11/01/11 - CHANGE NO. 15-11

(IX.B.5.)

6. To calculate the overpayment amount for an NCHC claim:
b. Add the overpayments for all ineligible children in the household together to obtain the total NCHC overpayment. Enter this amount in EPICS as the overpayment amount. The service code for NCHC premiums is 67.

REISSUED 11/01/11 - CHANGE NO. 15-11

(IX.B.6b.)

Determine ineligibility and calculate the overpayment as follows:

Since the period of ineligibility did not include any months on or after July 1, 2010, the total NCHC overpayment is $3,524.16. Enter this amount in EPICS with the service code 67 for NCHC.

REVISED 03/01/11 - CHANGE NO. 05-11

(IX.C.3.b.)

REVISED 03/01/11 - CHANGE NO. 05-11

(IX.C.3.b.)

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