Preventing Medicaid Recoupments From Retroactive Terminations | MyTherapyWizard

Preventing Recoupments: Eligibility Checks and Retro-Terminated Coverage

Preventing Recoupments - Eligibility Checks and Retro-Terminated Coverage - MyTherapyWizard help article card

Owners describe Medicaid plans recouping payments months later because coverage was retroactively terminated, even though the portal showed it as active. You can't prevent every retro-term, but saved eligibility responses are your best evidence in a dispute.

✨ Available on: Billing

🪄 In MyTherapyWizard

  1. Run batch eligibility checks through ClaimMD on a regular schedule, and single checks before evaluations.
  2. Review the saved results in the client's Insurance eligibility history.
  3. Use Service Stops to stop or flag services when coverage ends.
  4. Turn on COB flags, and block billing until a flag is resolved.
Batch eligibility checks through ClaimMD

You can run a single, some or batch your eligibility checks.  In this example below, Sally Cat's eligibility was checked along with others.  The "mismatches" tell me that insurance reported something different than what is recorded in MyTherapyWizard.  This is usually something like coverage end dates or changes in co-pays.   

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Select the updates by clicking them and then "push" them into the MTW record.  Now all of the updates are on the client's record with the historical changes as well. 



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Add a Service stop to anyone that shouldn't have a session.  Resolve it to remove it.  Clinicians see the service stop on schedules and appointments.  
Service Stops to stop, limit or flag services

💡 Why it matters: dated eligibility responses show you verified coverage in good faith when the payer says otherwise.

📚 See other articles in Practice Owners: Revenue & Compliance here.