Preclaim Review for Participating Providers of Medical Assistance Program Services and Items.

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* § 363-e. Preclaim review for participating providers of medical assistance program services and items. The department of health and the office of the Medicaid inspector general shall jointly develop requirements for preclaim review. Every service or item within a claim or encounter submitted by a participating provider shall be reviewed and verified by a verification organization prior to submission of a claim or encounter to the department of health or to a managed care provider as defined in paragraph (b) of subdivision one of section three hundred sixty-four-j of this title. The verification organization shall declare each service or item to be verified or unverified. Each participating provider shall receive and maintain reports from the verification organization which shall contain data on:

1. verified services or items, including whether a service appeared on a conflict or exception report before verification and how that conflict or exception was resolved; and

2. services or items that were not verified, including conflict and exception report data for these services.

* NB There are 2 § 363-e's



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