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Bulletin ID: No. 34 - Payment of Claims Submitted Above the Units Authorized

Wednesday, November 21, 2007

Effective November 1, 2007, in order to maximize your claim turnaround processing, please in ensure that all units claimed are authorized prior to submitting your claims. Billing for units with partial authorizations will result in a DMH denial.

For example if your agency is authorized to provide 32 units of a service and you submit a claim for 40 units, DMH will deny the entire amount of the claim. In order to correct this, your agency must resubmit the claim for units up to the amount previously authorized or adjust the authorization for the number of units required.

If you have additional questions, please contact your Provider Relations Specialist.