to decrease the administrative burden on enrolled fee-for-service Medicaid members and providers but will continue to meet the federal regulatory requirements at 42 CFR Part 456, Subparts A and B. This will be accomplished through continued utilization monitoring in a postpayment review process, with referral to the Office of Health Insurance Program (OHIP) prepayment Provider on Review Program, and to the Office of the Medicaid Inspector General (OMIG) where suspected fraud, waste or abuse are identified in the unnecessary or
inappropriate use of care, services or supplies by members or providers.
inappropriate use of care, services or supplies by members or providers.
State
Topics
Approval Date
Effective Date
File 1 - Approval Document Media