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Determining Usage
For purposes of determining and narrowing the potential MC overpayment period, the EW must request usage information from the local DHCS Investigation Unit by doing the following:
- Complete the “Confidential Medi-Cal Complaint Report” (MC 609).
- Request the usage information for the potential MC overpayment period in the “Details of Complaint” section of the MC 609.
- Specify if the information is required for a particular individual or for all the individuals in the MFBU/MC Tax Filing Household.
- Attach a copy of MEDS screen printout.
Mail the above information to DHCS Investigations Unit - MC.
When a potential overpayment is referred to the DHCS Audits and Investigations unit, DHCS will also review the amount paid by MC for managed care capitation on behalf of the client. The managed care capitation payment is the amount that DHCS agrees to pay the health plan contractor to provide health services to enrolled MC clients. When calculating potential overpayments, the managed care capitation payment is no longer considered part of MC usage.
Related Topics
Types of Potential Medi-Cal Overpayments