Provider Self-Audits

Trillium recommends provider agencies conduct periodic Self-Audits to identify instances where services reimbursed by Medicaid are not in compliance with program requirements. Self-Auditing is a critical component which can mitigate potential risks and facilitate resolution of matters potentially violating state or federal administrative rules, regulation or policy governing Medicaid or state-funded services. This includes matters exclusively involving overpayments or errors--not suggesting violation of the law.  It is the responsibility of the provider to notify Trillium in writing of any claims billed in error which will require repayment.

To refund a claim to Trillium, the provider should complete either a replacement claim or void the claim. The adjustment will process and will appear on the next Remittance Advice. Instructions on how to complete a replacement/void can be found on Trillium’s website in the Provider Documents and Forms as the Trillium Replacement and Voided Claims Process.  

Self–Audit Benefits: 

• Assist providers who feel they have potentially violated state or federal administrative law, regulation, or policy governing the Medicaid Program or state-funded services.
• Facilitate the resolution of matters exclusively involving overpayments or errors not suggesting violations of law.
• Allow for voluntarily disclosure of any overpayments or inappropriate payments of Medicaid or state funds