Self- Disclosure Program

Under New York State requirements, specifically Social Services Law (SOS) § 363‑d(6), Medicaid network providers are required to report, return, and explain any identified overpayments to Molina Healthcare of New York, Inc. / Senior Whole Health of New York, Inc. (collectively, Molina Healthcare) within sixty (60) days of identification, or by thedate any corresponding cost report was due, whichever is later, in accordance with Molina Healthcare’s established reporting process.

 

Reporting overpayments to the Molina Healthcare is required in addition to voiding or adjusting any affected claims, as claim adjustments do not fulfill the obligation to "report and explain" the overpayment.

 

You must report an overpayment to Molina Healthcare when you:

  • Received payment you are not entitled to under Medicaid, including routine billing errors, coordination‑of‑benefits issues, rate errors, authorization issues, or any claim paid incorrectly. 

  • Identified an error through internal review, audit, or post‑payment reconciliation.

  • Discovered incorrect units, incorrect service codes, duplicate payments, or other claim discrepancies.

 

An overpayment is considered identified when the provider has or should have determined (through reasonable diligence) that an overpayment occurred and has quantified the amount. 

 

Submission Process

  1. Complete the Required Form - Complete Molina Healthcare’s Provider Early Reversal Permission / Self‑Disclosure form in its entirety.

  2. Submit the Completed Form - Download the Form Here - Submit the completed form using one of the following methods 

    1. Fax Submission (Future Claim Deduction)

    1. Fax Number: 844‑305‑2186

    1. Subject Line:Provider Overpayment Self Disclosure – [Provider Name]

    1. Mail Submission (Form and Check)

    1. Mailing Address:
      Molina Healthcare
      Claims Recovery Department
      P.O. Box 744627
      Atlanta, GA 30374‑4627

  3. Confirmation of Processing - Confirmation of successful self‑disclosure processing will be reflected on your Explanation of Payment (EOP). Successful processing may include retractions and/or adjustment reason codes such as:

    1. Adjustment of Claim #

    2. Additional payment/recoupment approved based on payer‑initiated review or audit

    3. Claim Reversal

     

     

These indicators confirm that the self‑disclosure has been reviewed and resolved.

  

If these indicators do not appear on your EOP within forty‑five (45) days of submission to Molina Healthcare, please contact the Payment Recovery Contact Center at 866‑642‑8999 for assistance.

 

Other Disclosures

Pursuant to Title 18 of the New York Codes Rules and Regulations, Section 504.3, providers are required to prepare and maintain contemporaneous records demonstrating their right to receive payment under the medical assistance program and furnish the records, upon request. If a provider becomes aware that their records have been damaged, lost or destroyed they are required to report that informationto the Self-Disclosure Program as soon as practicable, but no later than thirty (30) calendar days after discovery.

 

Submission Process

Please contact your Provider Relations Representative for further guidance on the next steps.

For More Information

New York State Office of the Medicaid Inspector General’s Website

Self-Disclosure | Office of the Medicaid Inspector General (ny.gov)

Additional Resources

Webinars | Office of the Medicaid Inspector General