DMS says 70 providers owe 2021 reconciliation; agency will offset 2026 payments to recoup

Amy Richardson, Division Director of Fiscal Management at the Department for Medicaid Services, told the EMS Medicaid technical committee that the 2021 directed‑payment reconciliation is happening later than planned and that 70 of the 178 providers in that program owe money.

"So, in 2021, there were 178 providers in the program. I'm showing that there's about 70 that owe money back," Richardson said. She explained that, rather than asking those providers to mail checks, DMS will offset the amounts against their calendar‑year 2026 directed‑payment amounts. "If they had an overpayment from 2021 in the amount of $10,000, but they're owed $50,000 for 2026, we're only gonna pay them $40,000," Richardson said.

Richardson told the committee the reconciliation produced a net increase of about $2,000,000 flowing to providers overall, with both winners and losers within that net. She said DMS plans to process the MCO portion of the 2026 payments to managed‑care organizations by March 11 so MCOs can remit to providers shortly after they receive funds. Separately, Richardson said providers owed money will receive a distinct payment, and she expected those payments to go out the week of March 9.

The agency is still waiting CMS approval for the fee‑for‑service component of the 2026 program. "The fee‑for‑service piece of the program is not approved yet. We're still waiting on approval from CMS," Richardson said, noting a 90‑day review clock after submission and that DMS believed it was about two‑thirds of the way through that period.

Justin Daringer, director for the Division of Health Care Policy at the Department for Medicaid Services, asked providers to review and rebill claims denied for technical reasons (incorrect provider numbers, county codes, addresses or CPT codes). "When you don't do those things, of course, you don't get payments. When you leave $3 or $4 million, maybe more, just because you don't want to rebill, sometimes I would assume you would have financial situations," Daringer said.

Committee members asked about future audits and reconciliations for calendar‑year 2022; Richardson said DMS has contracted Myers and Software to work on 2022 results and will decide timing after those results are final.

Votes at a glance: the committee approved the minutes from the October 2025 meeting (motion by Linda, second by Mr. Phillips) and later voted to adjourn. No substantive policy actions were voted on during this meeting.

The committee scheduled its next meeting for April 27, 2–4 p.m.; leaders said the session will likely last 30–45 minutes.