Request for Medicaid Provider Documentation

CMS in partnership with the New York State Office of the Medicaid Inspector General (OMIG), is measuring improper payments in the Medicaid and State Child Health Insurance programs under the Payment Error Rate Measurement (PERM) program. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) statutes and regulations require the provision of such information upon request, and the information can be provided without patient consent. Documentation for medical review of randomly selected claims will be requested by A+ Government Solutions, Inc., the CMS contractor. If a providers’ claim is selected, the CMS contractor will request documentation to substantiate claims paid in federal fiscal year 2011 (October 1, 2010 – September 30, 2011 from the provider.) Please submit the specific medical documents for the patient, as requested in the letter you receive from the CMS contractor, directly to the CMS contractor with a copy to the OMIG. Requests for documentation began in July 2011.Requests and subsequent receipt/non-receipt of documentation will be tracked. Failure to provide requested records will result in a determination of erroneous payment, and the OMIG will pursue recovery. Source: NY State Medicaid newsletter July 2011 VOLUME 27 – NUMBER 10