OMIG Resumes Semiannual TPL Case Requests Using Traditional Appeals 

The state Office of the Medicaid Inspector General (OMIG) has resumed its semi-annual demand billing process for the second half of federal fiscal year (FFY) 2019.

Details are outlined in a letter (mailed on March 2, 2020) that most Medicare-certified home care providers should have received from OMIG and its Third Party Liability (TPL) contractor, the University of Massachusetts Medical School (UMMS).

HCA has heard from multiple CHHA members very concerned about being able to comply with OMIG’s request to submit demand bills to Medicare (as well as subsequent documentation) in light of the COVID-19 pandemic, especially with many administrative employees working from home or on other activities.  We have conveyed these concerns to officials at UMMS and will be speaking with officials at OMIG to see if any relief or flexibility can be given to CHHAs working to comply with this latest request.

The letter identifies which cases have been selected to undergo appeals (through demand billing), with dates of services that occurred in the third and fourth quarters of FFY 2019 only (April 1, 2019 through September 31, 2019) or the end of the episodic period billed to Medicaid.

UMMS’s letter also says providers should continue monitoring the status of their demand bill claim(s) once submitted. Providers are required to correct any claims that are rejected or suspended by the Medicare Administrative Contractor (MAC), National Government Services (NGS). In addition, providers are required to timely submit a complete medical record to NGS once the Additional Development Request (ADR) is issued.

A final remittance advice for each episode billed (by demand bill) will be issued within 60 days of the final bill submission to Medicare. Upon receipt of the final remittance advice, providers must send copies of the following documents to the TPL contractor, UMMS, within 10 business days:

  • The original claim submitted to the MAC for each 60-day episode billed. 
  • The final claim remittance advice sent to you from the MAC. 
  • Each medical record your agency submitted to the MAC upon the ADR request.

HCA members interested in knowing whether they should have received a letter from OMIG can e-mail HCA at