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 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
1.3 Definitions . 1.4 State Collaboration Purpose. 1.5 Complaint and Lead Screening. 1.6 Vetting Process . 1.7 Investigation Review Process + 1.7.1 Initiation of an Investigation. 1.7.2 Release of Medicaid Data to UPIC. 1.7.3 Extrapolation. 1.7.4 Look Back Period. 1.7.5 Medical Review for Program Integrity Purposes. 1.7.6 Request of Medical Records
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