Medicaid Managed Care Overpayment Recoupments

Recently, the Medicaid managed care health plans announced that they are required to recoup overpayments made on claims for October 2025 dates of service. These overpayments are the result of the October 1 Medicaid rate reductions. The health plans announced that the managed care recoupments would not take place until November 1, in case the legislature allocated funds to address the rate reductions. 

The recoupment process for Medicaid managed care claims involves letters being sent to providers for each impacted claim. Providers then have a mandated time in which to respond before any recoupment can take place.  

If a provider wants to avoid the additional administrative steps and time involved with the October overpayment recoupment, they have the option to delay filing their October Medicaid managed care claims until November 1.