MEDICAID PROGRAM INTEGRITY MANUAL CHAPTER …

MEDICAID PROGRAM INTEGRITY MANUAL CHAPTER 1 MEDICAID INTEGRITY PROGRAM (MIP) Table of Contents (Rev. 10384, Issued: 10-09-20) Transmittals for CHAPTER 1 Basis of Authority Statutory/Regulatory Citation Background Definitions State Collaboration Purpose Complaint and Lead Screening Vetting Process Investigation Review Process + Initiation of an Investigation Release of MEDICAID Data to UPIC Extrapolation Look Back Period Medical Review for PROGRAM INTEGRITY Purposes Request of Medical Records Review of Medical Records Completion of a Medical Records Review Overpayment Assessment Documentation of Investigation and Medical Review Findings Overpayment Resolution Process Calculation of FFP Based on State s Date of Expenditure State Appeal Process Close-Out Letters MEDICAID Settlement Negotiations Requests for Information MEDICAID Payment Suspensions Prepayment Medical Review Revocations and Terminations

MEDICAID PROGRAM INTEGRITY MANUAL C HAPTER 1 – M EDICAID I NTEGRITY P ROGRAM (MIP) Table of Contents (Rev. 10384, Issued: 10-09-20) Transmittals for Chapter 1 . 1.1 Basis of Authority – Statutory/Regulatory Citation

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