OMIG Resumes Semiannual TPL Case Requests Using Traditional Appeals (September Update)  

Situation Report | September 8, 2020

The state Office of the Medicaid Inspector General (OMIG) has resumed its semi-annual demand billing process for the first half of federal fiscal year (FFY) 2020.

Details are outlined in a letter (mailed on August 31, 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). 

The letter identifies which cases have been selected to undergo appeals (through demand billing), with dates of services that occurred in the first and second quarters of FFY 2020 only (October 1, 2019 through March 31, 2020) 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