Iowa’s Medicaid program is managed through three managed care organizations: Amerigroup Iowa, AmeriHealth-Caritas Iowa and UnitedHealthcare Plan of the River Valley. IHA has created this Web page as a resource for hospitals as they work with these organizations and serve Medicaid beneficiaries.
IHA Technical Advisory Group
ER Recoupment Causing Issues for Hospitals
IHA continues to hear concerns from hospitals that have received recoupment notices from Medicaid Managed Care Organizations (MCOs) regarding claims originating from the emergency room (ER) that contain billing codes that are considered “non-emergent.”
The following Iowa Medicaid Enterprise (IME) informational letters describe the evolution of this policy which passed by the Legislature 2011.
Hospitals have indicated that the list of ICD-10 codes being used to determine this recoupment is incomplete and inaccurate and does not include a number of codes that are used in the ER, particularly those related to behavioral health. IHA has learned that IME is aware of this issue and will be providing an updated code list to MCOs.