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Ohio Medicaid Announces Claims Corrections

Thanks to the persistence of OPA Independent SIG Chairman Dom Bartone consistently pointing out pricing errors, Ohio Medicaid has released the following statement.

Ohio Medicaid is working to correct errors on claims that were paid at an incorrect rate for dates of service in August and September 2011.  This happened when manufacturer price increases were not applied timely. Adjustments are only being made if the change will result in a higher net payment to the pharmacy; no funds will be recouped for any changes to a lower rate.

These claim adjustments will begin to show on your remittance advices in early September and will continue for several weeks.  You will see both a reversed claim at the original amount and a new claim at the higher amount.

If you have questions about specific claims, please email Medicaid_pharmacy@jfs.ohio.gov
or leave a message at 614-752-3068.

This absolutely underscores the importance of keeping on top of pharmacy remittances and contacting Ohio Medicaid when payment is incorrect.

Kelly Vyzral
Director of Government Affairs
OhioPharmacists Association