MME Claims Review/Reprocessing Project
April 4, 2025
We are reaching out to inform you of an ongoing review and reprocessing effort concerning claims submitted for Medicaid members who are also enrolled in Medicare (MME).
An in-depth analysis was conducted to verify two key factors:
- The existence of valid Medicare coverage for the members
- Whether services were appropriately billed to Medicare before being submitted to Medicaid
Upon review, it was determined that certain claims were either not billed to Medicare or were not paid by Medicare prior to Medicaid adjudication. As a result, Medicaid may have incorrectly paid as the primary payer.
The project, referenced under Project Number: PROJ-59443882, is currently in process with an estimated completion date of July 30, 2025.