{"data":{"id":"us-va/12vac30-90-257","jurisdiction":"us-va","citation":"12VAC30-90-257","heading":"Credit balance reporting","body":"A. Definitions. The following words and terms when used in this regulation shall have the following meanings unless the context clearly indicates otherwise:\n\n\"Claim\" means a bill consistent with 12VAC30-20-180 submitted by a provider to the department for services furnished to a recipient.\n\n\"Credit balance\" means an excess or overpayment made to a provider by Medicaid as a result of patient billings.\n\nB. Credit balances may occur when a provider's reimbursement for services it provides exceeds the allowable amount or when the reimbursement has been for unallowable costs, resulting in an overpayment. Credit balances also may occur when a provider receives payments from Medicaid or another third party payer for the same services.\n\nC. For a credit balance arising on a Medicaid claim within three years of the date paid by the department, the NF shall submit an adjustment claim. For credit balances arising on claims over three years old, the NF shall submit a check for the balance due and a copy of the original DMAS payment.\n\nD. A periodic audit shall be conducted of an NF's claim adjustments of Medicaid credit balance data. NFs shall maintain an audit trail back to the underlying accounts receivable records supporting each claim adjusted for credit balances.","path":["Title 12. Health","Agency 30. Department of Medical Assistance Services","Chapter 90. Methods and Standards for Establishing Payment Rates for Long-Term Care","Part II. Nursing Home Payment System Subpart I General","Article 2. Capital Cost Applicable"],"source_url":"https://law.lis.virginia.gov/admincode/title12/agency30/chapter90/section257/","current_through":"2026 Regular Session (effective July 1, 2026)","vintage":"","retrieved_at":"2026-09-14T04:51:02Z","sha256":"19dfa1621b26550f7ff35b5d06dae1a4ae3458bd1f5d9ece2b4122d5e74b721f","source_id":"us-va-vac","stale":false,"prev":"us-va/12vac30-90-255","next":"us-va/12vac30-90-258"},"notice":"GroundRules: Original legal text. Not legal advice."}