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HMS outlines automated review to flag same‑day duplicate payments; providers ask about carve‑outs
Summary
HMS described an automated matching process to identify same‑day duplicate payments where managed care and fee‑for‑service both paid for the same date of service; HMS said common carve‑outs (behavioral health, dental, hospice, long‑term care) are excluded and the review covers inpatient, outpatient and professional claims.
HMS staff presented an automated review designed to identify instances where the same service, patient, provider and date of service were paid by a managed‑care entity and also by fee‑for‑service, leaving the FFS payment as a likely overpayment.
"What we're doing is we're identifying, essentially duplicate claims," Matt from HMS said,…
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