Carelon Recouping Overlapping PRP Payments (EOP Code PRPP)

Check your next PSV for EOP code PRPP. It means Carelon has reversed a PRP claim because another provider was also paid for the same participant and service month.

If you see it

• Confirm the participant's admission date, discharge date (if any), and whether another PRP served them that month.
• If you dispute the reversal, file a Provider Claim Appeals Request Form with: the check or EFT number and payment date from the PSV; the claim numbers, participant, dates of service and procedure codes; a plain explanation of why the services were not duplicative; and the intake, discharge, transition or care coordination records that prove it.
• Provider Manual references: Chapter 12 (claim appeals) and Chapter 17, section 17.03 (recoupments and offsets).

Preventing the next one

Ask about prior and concurrent PRP enrollment at intake, document the handoff with the other program, and close your own enrollment with a discharge date the month a participant leaves.

Full write-up, including the related September 21 PRP-M combination-of-services rules: Carelon Is Recouping Overlapping PRP Payments. Here Is What Your Records Need to Show.