Claims Payment Systemic Error (CPSE) Reports

In accordance with the expectations of the Ohio Department of Medicaid (ODM), and as outlined in the Medicaid Managed Care Provider Agreement between ODM and AmeriHealth Caritas Ohio, we will communicate to providers when claims adjustments are processed for incorrectly underpaying, overpaying, denying, or suspending claims that impact, or have the potential to impact, five or more providers. Cases that meet these criteria are defined as Claims Payment Systemic Errors (CPSEs). On a monthly basis, at a minimum, AmeriHealth Caritas Ohio releases a Claims Payment Systemic Error (CPSE) report and posts it on this page. 

Current edition

June 2024 (PDF)