Post-payment review process.

  1. Law
  2. CFR 42
  3. Public Health
  4. Centers for Medicare & Medicaid Services, Department of Health and Human Services
  5. Medical Assistance Programs
  6. Utilization Control
  7. Utilization Control: All Medicaid Services
  8. Post-payment review process.

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§ 456.23 Post-payment review process.

The agency must have a post-payment review process that -

(a) Allows State personnel to develop and review -

(1) Beneficiary utilization profiles;

(2) Provider service profiles; and

(3) Exceptions criteria; and

(b) Identifies exceptions so that the agency can correct misutilization practices of beneficiaries and providers.


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