Service Verification. To assist DHCS in meeting its obligation under 42 CFR 455.1(a)(2), the Contractor shall establish a mechanism to verify whether services were actually furnished to beneficiaries.
Service Verification. (A) The Contractor shall have policies and procedures to verify, by sampling or other methods, that services billed by Providers were received by the Contractor’s Enrollees.
(B) If the Contractor uses sampling procedures specified below to verify that services were provided, the Contractor's written policies and procedures must include that:
(1) annually, the Contractor shall randomly select a minimum of 50 individual Enrollees who received a Covered Service during the SFY for service verification;
(2) the Contractor shall keep a record of each Enrollee contacted for service verification that includes:
(i) the Enrollee’s name and Medicaid ID number;
(ii) the date of each contact (if a prior attempt was unsuccessful);
(iii) the method of contact;
(iv) whether the Enrollee responded to the contact; and
(v) whether the Enrollee indicated he or she obtained the service; and
(3) the Contractor shall keep copies of correspondence.
(C) If the Contractor uses methods other than the sampling procedures specified in Article 6.1.6(B) of this attachment to verify services billed by Providers were received by the Contractor's Enrollees, the Contractor's written policies and procedures shall include a detailed description of the method(s) to be used.
Service Verification. The Contractor shall have policies and procedures to verify that services billed by Providers were received by the Contractor’s Enrollees. The Contractor’s policies and procedures must include the following:
Service Verification. (A) The Contractor shall have policies and procedures to verify that services billed by Providers were received by the Contractor’s Enrollees. The Contractor’s written policies and procedures must include that:
(1) annually, the Contractor shall randomly select a minimum of 50 individual Enrollees who received a Covered Service during the SFY for service verification; and
(2) the Contractor shall keep a record of each Enrollee contacted for service verification that includes:
(i) the Enrollee’s name and Medicaid ID number;
(ii) the date of each contact (if a prior attempt was unsuccessful);
(iii) the method of contact;
(iv) whether the Enrollee responded to the contact;
(v) whether the Enrollee indicated he or she obtained the service; and
(3) the Contractor shall keep copies of correspondence.
(B) The Contractor shall keep sufficient documentation to allow the Department to verify that service verifications have been performed.
Service Verification. To assist the Department in meeting its obligation under 42 C.F.R. § 455.1(a)(2), the Contractor shall have a way to verify whether services were actually furnished to beneficiaries.
Service Verification. (A) The Contractor shall have policies and procedures to verify that services billed by Providers were received by the Contractor’s Enrollees. The Contractor’s written policies and procedures must include the following:
(1) annually, the Contractor shall randomly select a minimum of 50 individual Enrollees who received a Covered Service during the state fiscal year for service verification; and
(2) the Contractor shall keep a record of each Enrollee contacted for service verification that includes:
(i) the Enrollee’s name and Medicaid ID number;
(ii) the date of each contact (if a prior attempt was unsuccessful);
(iii) the method of contact;
(iv) whether the Enrollee responded to the contact; and
(v) whether the Enrollee indicated he or she obtained the service;
(3) the Contractor shall keep copies of correspondence.
(B) By November 1st of each year, the Contractor shall submit a report to the Department, in a Department specified format, documenting that service verifications were performed.
Service Verification. (A) The Contractor shall have policies and procedures to verify that services billed by Providers were received by the Contractor’s Enrollees. The Contractor’s policies and procedures must include the following:
(1) annually, the Contractor shall randomly select a minimum of 50 individual Enrollees who received a Covered Service during the state fiscal year (SFY) for service verification; and
(2) the Contractor shall keep a record of each Enrollee contacted for service verification.
(B) By November 1st of each year, the Contractor shall submit a report to the Department, in a Department specified format:
(1) the names and ID numbers of all Enrollees contacted for service verification;
(2) whether the Enrollees were contacted via telephone, email, or other method;
(3) whether the Enrollee responded to the service verification; and
(4) whether the Enrollee indicated he or she obtained the service during the prior fiscal year.
(C) The Parties understand and agree that the Department will annually conduct an audit to ensure that the service verification was conducted by the Contractor. The Contractor shall keep sufficient documentation to ensure that the Department can verify that the service verification was performed.
Service Verification. Contractor must have a method to verify whether services were actually furnished to Enrollees.
Service Verification. On a regular basis, the Mental Health Plan performs service verification to verify with the beneficiary that they actually received the services that were claimed for by the Contractor. Contractor shall notify the Mental Health Plan of any beneficiary change of address per the Mental Health Plan’s Policy and Procedure on “Service Verification” which can be accessed through the following link: xxxx://xxx.xxxxxx.xxx/providers/QA/docs/qa_manual/15-1_SERVIC_VERIFICAT_POLICY.pdf
Service Verification. (a) For each episode of service, the provider to retain a record of the consumer's name; service date; provider's signature; and consumer's signature.
(b) In the AAA-provider agreement, the AAA shall not prohibit the provider from using a technology-based system to collect and retain the items in paragraph (B)(4)(a) of this rule.
