Page 93
Title 5: Centrally Administered Programs Page 84 Iowa Department of Human Services Employees’ Manual Chapter E: Healthy and Well Kids in Iowa (hawk-i) Recovery Revised August 20, 2010
Premiums incorrectly paid to a health plan on behalf of an enrollee due to an administrative error are not subject to recovery from the enrollee. An “administrative error” is defined as an action attributed to the Department or to the hawk-i third-party administrator that results in incorrect payment of benefits, including premiums paid to a health and dental plan, due to one or more of the following circumstances: ♦ Misfiled or lost a form or document. ♦ An error in typing or copying. ♦ A computer input error. ♦ A mathematical error. ♦ Failure to determine eligibility correctly when all essential information was available to the hawk-i third-party administrator. ♦ Failure to request essential verification necessary to make an accurate eligibility determination. ♦ Failure to make timely revision in eligibility following a change in policy requiring application of the policy change as of a specific date. ♦ Failure to issue timely notice to cancel benefits, resulting in benefits continuing in error. ♦ Failure of the Department to provide correct information to the hawk-i third-party administrator regarding a child’s Medicaid eligibility. Complete form 470-0464, Overpayment Recovery Information Input, when you determine that premiums have been incorrectly paid to a health and dental plan due to a client error, regardless of the amount. In addition, complete form 470-0465, Overpayment Recovery Supplemental Information, when the amount incorrectly paid to a health and dental plan due to client error exceeds $1,000.00. Send these completed forms along with documentation of the overpayment calculation and any written proof substantiating the client error to: Iowa Medicaid Enterprise Bureau of Adult and Children’s Medical Programs ATTN: hawk-i Overpayments 100 Army Post Rd. Des Moines, Iowa 50325 Please mark the envelope “DO NOT SCAN.” The enrollee has the right to appeal a decision to recover an overpayment. See Appeals for more information.