The West Virginia Bureau for Medical Services has notified the WVSMA that duplicate payments were sent to physicians and other providers during recent claims processing cycles. It has been determined that duplicate payments occurred during the claim processing cycles beginning in December, 2007, and continuing through June, 2008. The Bureau for Medical Services (BMS) and Unisys have been working together to build safeguards to prevent these errors from re-occurring in the future.
In the meantime, physicians who received duplicate payments are being contacted via mail and sent a report that provides a listing of all claims that were paid in error. These duplicate payments will be reversed by Unisys in thirty days. This means that the duplicate payments will be taken from future remittances.
What you need to do:
If you disagree with the findings, you must contact the Unisys Research Department at (304) 348-3200. After discussion and research, Unisys will issue a written reconsideration, either upholding, reversing or modifying the original finding. If you disagree with the reconsideration, you may appeal within thirty (30) days from receipt of the reconsideration.
If you disagree with the decision following the reconsideration, you may request an administrative review within thirty days of receipt of the determination. The request for administrative review must be in writing and signed, with the details of the items in contention included. You must also identify the provider representatives who will be present at the review conference.
Letters must be addressed to:
Commissioner, Bureau for Medical Services
350 Capitol Street, Room 251
Charleston, WV 25301-3707
If you receive a letter stating that you have received duplicate payments and have additional questions, you may contact Barbara Good, WVSMA Physician Practice Advocate, at (304) 925-0342, ext. 11, or via email Barbara@wvsma.com.
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