Agenda - 09-04-2014 - 6e - Laserfiche WebLink

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10 d North Carolina Department of Health and Human Services Division of Medical Assistance Pat McCrory Governor Orange County Emergency Services Attn: Administrator 510 Meadowlands Drive Post Office Box 8181 Hillsborough, North Carolina 27278 2 Dear Administrator: AWona Z. Wos, M,D- Ambassador (Ret.) Secretary DHHS Robin Gary Cunnnings, M,D. Deputy Secretary for fle:alth Services, Director,, Division of Medical Assistance June I , 2014 RE: Ambulance Tentative Settlement Provider: Orange County Emergency Services NPI #: 1629178629 Provider #: 34-6'929 FYE:June 30, 2013 Enclosed is your tentative settlement of the above provider's North Carolina Medicaid cost report for the fiscal period June 30, 2013 used on a limited scope review, The above: Medicaid cost report has been selected for field audit or desk review. The Notice of Program Reimbursement and final settlement will be issued upon completion of the field audit or desk review, The enclosed Attachment A summarizes the settlement, If Line 7 of the Attachment A indicates an amount due the Medicaid Program, please remit that amount to: DHHS Office of the Controller, Accounts Receivable- Medical Assistance, 2022 Mail Service Center, Raleigh, North Carolina 27699-2022, Should payment not be received by the Division within thirty (30) days, from the date of this letter, a late payment penalty and monthly interest will be charged consistent with N.C.G,S §105 241,21 and as required by MC. G.S, §147- 56,23. In accordance with such authority, if this letter reflects a revision of a previously determined settlement amount, penalties and interest shall be recalculated on the revised settlement arnount and interest will be charged from the original due date: of the account. In accordance with Section 10,73A (a) and (c) of N. C. Session Law 2009- 451, any payments to your provider organization (or any entities sharing the same: Employee Identification Number as your Medicaid provider organization) for claims submitted to N,C Medicaid shall be: suspended thirty (30) days, from the date of this letter until the recoupme:nt and any penalty and accrued interest has been paid in full or you have entered into an approved payment plan, The suspension of payments shall continue during the pendency of any appeal filed at the Department, Office of Administrative Hearings, or State or www,ncdhhs.gov Tel, 919-855-4 100, • Fax 919-733-6608 Location: 1985 Urnstead Drive - Kirby Building - Raleigh, NC 27603 Mailing Address: 2501 Mail Service Center - Raleigh, NC 27699-2501 An Equal Opportunity / Affirniative Action Employer