Transcription of MEDICAID PROGRAM INTEGRITY MANUAL CHAPTER …
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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
broader vulnerabilities to the integrity of the Medicare and Medicaid programs including, but not limited to: • Proactively identify incidents of potential fraud, waste, and abuse that exist within its service area and take appropriate action on each case; • Investigate allegations of fraud made by beneficiaries, providers/suppliers, CMS,
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