Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.28 - Reimbursement
Rule 37.86.2820 - DESK REVIEWS, OVERPAYMENTS, AND UNDERPAYMENTS

(1) Upon receipt of the cost report, the department will instruct the Medicare intermediary to consider Medicaid data when they perform a desk review or audit of the cost report and determine whether a Medicaid overpayment or underpayment has resulted.

(2) For cost reporting purposes where the department finds that an overpayment has occurred, the department will notify the provider of the overpayment.

(3) For cost reporting purposes in the event an underpayment has occurred, the department will reimburse the provider within 60 days from the date of the initial notification to the provider.

(4) When the upper payment limit has been exceeded based on filed cost reports the department will recover the overpayment amount. The department will collect overpayments using the following methodology:

(5) Providers aggrieved by adverse determinations by the department may request an administrative review and fair hearing as provided in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.