Attention: Outpatient Hospital Providers
A review of OPPS dental claims with dates of service (DOS) from January 1, 2023, through December 31, 2023, identified dental codes that were incorrectly reimbursed, resulting in overpayments. Only the identified overpayment amount will be recouped.
Gainwell Technologies (Gainwell) will process a mass adjustment to the impacted claims. The adjustment will appear on your remittance advice dated October 26, 2026.
Providers impacted by this Mass Adjustment (MA) should submit a corrected claim for payment. In the event that the corrected claim(s) deny for timely filing, providers are reminded that in accordance with Part 200, Rule 1.8(A)(2), providers may request an Administrative Review regarding claims within ninety (90) calendar days of the denial of a claim, when the Division of Medicaid adjusts claims after timely filing and timely processing deadlines have expired. Requests for an Administrative Review must include documentation that explains the facts that support the provider’s position as to how the denied claim meets one (1) or more of the requirements in Miss. Admin. Code, Title 23, Part 200, Rule 1.8(A) and the reasons the provider believes he/she complied with Medicaid regulations, and other documentation as required or requested by the Department of Medicaid (DOM).
Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative. The Provider Field Representative list includes email addresses and phone numbers for each representative.