Notification Requirements For Health Care Policy And Financing Audit

The act requires that, prior to initiating a review or audit of a medicaid provider's records, the reviewer or auditor, or a qualified agent contracted with the department of health care policy and financing (state department) shall confirm the provider's contact information with the provider. After confirming the provider's contact information, the reviewer or auditor, or qualified agent, shall notify the provider of additional information concerning the review or audit.

Current law requires the reviewer or auditor, prior to initiating the review or audit, to deliver to the provider not less than 10 business days prior to the commencement of the audit a written request describing in detail such records and offering the provider the option of providing either a reproduction of such records or inspection at the provider's site. The act requires the written request to be provided through both e-mail and certified mail.

The act requires the state department to ensure providers understand the relationship between the state department and the qualified agent and how to contact the qualified agent prior to a qualified agent commencing any review or audit.

(Note: This summary applies to this bill as enacted.)