Durable Medical Equipment (DME) Upper Payment Limit (UPL) Reprocessing Accounts Receivable (AR) Request Form
Resetting the AR to 0% prior to the clean-up implementation requires an AR increase afterwards to recoup incorrect payment. Fill out the form below. If choosing a customized AR rate, an email will be sent by the Department of Health Care Policy & Finance (the Department) regarding request approval.
If approved, the customized rate requested will be the auto-recoupment rate after the DME UPL implementation is complete.