23-248 Missed January and February Capitation Payments to Be Paid in March

Date: 03/03/23

CMS processing error caused MARx to calculate no payments for January and February

A Centers for Medicare & Medicaid Services’ (CMS’s) processing error may have impacted your capitation for January and February 2023.

There are member discrepancies with the CMS January and February monthly membership reports (MMRs) causing members to be missing from payment files. These discrepancies impacted plan‐submitted rollover enrollments with a start date of January 2023 that were submitted between October 4, 2022, and October 7, 2022.

Wellcare by Health Net* (WCBHN) did not receive payment from CMS for certain members because of this CMS error. Therefore, our capitated participating physician groups and capitated hospitals did not receive payments from WCBHN for these members.

We have been informed that CMS has resolved this issue and will make retroactive payments.

Your March 2023 capitation payment will be distributed on or aroundMarch 12th. This payment will include both January and February 2023 missing capitation payments.

Additional information

Providers are encouraged to access the provider portal for real‐time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

For additional information, refer to CMS letter (PDF) dated January 31, 2023.

For all other questions contact the Provider Services Center at 800‐929‐9224.

 

This information applies to Participating Physician Groups (PPGs) and Hospitals.