Medicaid In-Home Services Programs, Department of Public Health And Human Services : Performance Audit 1998

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Providers can submit bills for a day, a week, two weeks, a month or any other period they desire. As a result, it is not possible to generate a report hsting providers who submitted claims with amounts in excess of the weekly limits. If providers were required to submit personal assistance claims on a weekly basis, the bureau could generate a report to determine which agencies are billing in excess of the weekly limits.
Page 33 Chapter IV - Personal Assistance Services Program The Medicaid Mana
...gement Information System (MMIS) is used by the fiscal intermediary to process personal assistance claims. As currently programmed, the system uses a "rolling" weekly span for Medicaid claims. As a result of the "rolling" span, a provider can submit for a week of services beginning January 1 and submit for a week of services beginning January 4, and be paid for both. The system does not have a control to flag claims which are submitted for overlapping weeks. A random review of provider claims by bureau staff could be used to identify these types of claims.

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