Oklahoma Did Not Correctly Process Adjustments to Medicare Crossover Claims

Although Oklahoma received crossover claim adjustments, it did not have any policies and procedures for processing adjustments to Medicare crossover claims. As a result, Oklahoma did not recoup amounts due from providers or pay amounts owed to providers when an adjustment to a crossover claim changed the original deductible or coinsurance payment amounts.

We recommended that Oklahoma develop and implement policies and procedures to ensure adjustments to Medicare crossover claims are correctly processed.

In written comments on our draft report, Oklahoma indicated that it "mildly" concurred with the finding. It agreed that it did not process adjustments from Medicare and stated that its Medicaid Management Information System (MMIS) denied them for lack of adequate information. Oklahoma included information about the difficulties in processing adjustments, indicating that the issue could be attributed to multiple parties. It also identified system changes it made to its MMIS and stated that its new process should resolve the issues identified in our audit.