What amount will the West Virginia Department of Health and Human Resources deny a claim or require reimbursement for?

The correct answer is based on the specific threshold that the West Virginia Department of Health and Human Resources uses to determine when a claim may be denied or require reimbursement. This threshold is set at amounts exceeding $1,200. When a claim reaches this limit, it signals potential issues, such as the need for additional scrutiny or verification regarding the associated services or expenses. Claims smaller than this amount typically do not face the same level of scrutiny, meaning that they are generally processed without the need for further validation of the costs involved.

Knowing this allows practitioners to ensure that they are compliant with existing regulations and provides guidance on claim submissions to avoid any unnecessary delays or denials. Claims above this threshold tend to indicate a greater complexity or expense that might necessitate a deeper review by the department, ensuring that resources are allocated appropriately and that the integrity of the claims process is maintained.