Your Medicaid MCO stopped paying. Don't wait. Here's what to do.
When a Medicaid MCO stops paying. or starts denying en masse. you have a 30-60 day window to recover before the cash crisis is irreversible. This page covers the immediate triage steps + the longer-term defense.
First 72 hours: triage
Confirm whether it's all your claims or specific service lines. Pull last 90 days of denied claims and group by CARC code. Identify whether the denials trace to a payer policy change, your contract status, or your credentialing status. The right intervention depends on the cause.
Common MCO non-payment causes
Contract status changed (provider termination, non-renewal); credentialing lapse during recredentialing window; payer policy update you missed (Optum NPI/taxonomy rollout is a recent example); claim format error from EHR/clearinghouse change; payer adjudication system error (yes, this happens).
Escalation path inside the MCO
Provider Relations is rarely the right channel. Network Management or your assigned Network Account Manager handles material disputes. If they don't respond in 5 business days, escalate to State Medicaid Provider Ombudsman. File written complaint with attorney general for systemic non-payment.
Cash protection while you resolve
Accelerate other payer collections. Negotiate net-60 vendor payment extensions. Tap your line of credit before you need it. Communicate transparently with leadership about runway.
Free emergency consultation
Pick up the phone. ASP-RCM senior partners do same-day consultations on Medicaid MCO non-payment situations. No sales pitch. Diagnostic conversation. 30 minutes. Sometimes we end the call recommending you don't need us; either way you leave with a plan.
Don't wait. Get a senior partner on this.
ASP-RCM senior partners do same-day consultations on operational distress situations. 30 minutes. No SDR triage. Diagnostic conversation. You leave with a plan whether or not you engage us further.