Recoupment Project and Application of 'Lesser Of' Logic

March 18, 2025

As part of our standard payment processing rules, we have updated our configuration to apply the ‘less of’ logic to waiver provider payment rules. This means that payments will not exceed the amount billed on each service line.

Additionally, recoupment will be initiated for any services where the payment exceeded the billed amount. These changes ensure alignment with standard payment policies and maintain consistency in reimbursement processing.