A Couple of Things About Rates and Billing

June 17, 2025

The following Item is, and has been in the Budget for a number of years.


Item 288 I 3. In every June, the remittance that would normally be paid to providers on the last remittance date of the state fiscal year shall be delayed one week longer than is normally the practice. This change shall apply to the remittances of Medicaid and FAMIS providers. This change does not apply to providers who are paid a per-month capitation payment. The department shall have the authority to implement this reimbursement change effective upon passage of this Act, and prior to the completion of any regulatory process undertaken in order to effect such change.



This should answer the questions that have been flying around this morning!  And on a related note – DMAS pays up to the allowable amount for any unit of service and does not pay greater than that amount.   So if there is a question about the validity of a rate; if DMAS paid it, it can be considered valid.   If a provider bills more than the DMAS allowable rate because it is their “usual and customary” amount; DMAS will only pay their allowable amount.   If, however, a provider bills less than the DMAS allowable amount, DMAS will pay that lesser amount.