MedicaidReimbursementMedium impact
Recoupment of Some Enhanced Payments Made to PCPs under Affordable Care Act (ACA)
Illinois Medicaid - HFS·IL · Internal Medicine, Family Medicine, Pediatrics·Provider Notice
Effective date
Mar 10, 2014
We identified it
Jun 20, 2026
Summary
Enhanced ACA payments made to Primary Care Physicians for Medicaid patients between January 2013 and November 2013 will be recouped if they were incorrectly paid for Title XXI and state-funded program patients instead of Title XIX Medicaid patients. The recoupment affects 3-4% of total enhanced payments and will be deducted from future ACA payment vouchers using Adjustment Reason Code 3317.
Action Required
Immediately: Billing team should monitor remittance advices for Adjustment Reason Code 3317 (ACA Pmt Recoup/Client Category Ineligible) which indicates recoupment of erroneous enhanced payments. Contact Bureau of Professional and Ancillary Services at 1-877-782-5565 with questions about specific recoupments. No action needed to prevent future recoupments as the billing error was corrected November 17, 2013.