Public Health Department (PHD)

 

Refund Recovery Policy 

It is the BRC's policy to pursue reimbursement for claims that SBCPHD has paid to providers through the now-terminated MIA Program, Tobacco Settlement Funds or other programs if the patient is found to have another payer or source of payment, has become retroactively eligible for another program, or if there has been a billing or payment error made by the provider or by the BRC. According to the Medi-Cal Provider Manual, Part 1– Medi-Cal Program and Eligibility, Provider Regulation, the California Welfare and Institutions Code, Section 14019.3, states that a recipient, or any person on behalf of a recipient, who has paid for health services otherwise covered by Medi-Cal and received by the recipient, is entitled to a return of any part of the payment from the provider. MediCal Provider Manual (see page 15).

 

Process 

  • BRC will send providers a spreadsheet and/or a separate letter requesting refunds for patients who have become Medi-Cal eligible or who have been found to have another source of payment or for billing or payment errors.
  • Refunds related to errors or because the patient was found to have private insurance are expected to be reimbursed within 60 days.
  • Refunds requested because the patient has become Medi-Cal or Medicare eligible are expected to be reimbursed within 90 to 120 days unless an extension is requested.
  • In the case that the provider does not reimburse the BRC within the 120 day period, the BRC will recoup the money by offsetting current claims. Claims used to offset refunds will exclude those of patients who are pending Medi-Cal or are found to have other payer sources.
  • The request for refund may be forgiven by the BRC Program Coordinator in the case that the provider sends a copy of the denial letter from CenCal, Medi-Cal, and/or Medicare with the request for refund. If the reason for denial can be appealed, the BRC Program Coordinator will assist the provider in appealing the denial if necessary.

 

Please send refunds, denials, extension requests and other correspondence to:
SBCPHD Benefits and Referral Center
300 N. San Antonio Road
Room B 100
Santa Barbara, CA 93110
 
For questions regarding refund requests:
Email: PHDBRC@sbcphd.org
Phone: (805) 681-5393
FAX: (805) 681-5424

Benefits and Referral Center - 300 N San Antonio Rd,  Room B100, Santa Barbara, CA 93110
Telephone: (805) 681-5393 * FAX: (805) 681-5424