Pre-payment Analytics

March 27, 2017

The Governor has signed the bill requiring DMAS to establish a new contract to establish pre-payment analysis of claims for FFS providers and allow delay of reimbursement pending resolution.   Our concern, expressed to the patron, the various committees and to the Governor, is that the large majority of the FFS providers are those in the DD Waiver.  The intent – to save a considerable sum of money – will, therefore, potentially put our cash flow a some significant risk.

The systems currently in place, including pre authorization, do prevent the kinds of claims which typically are identified in this kind of audit.  We will continue to work with DMAS as this contract is drafted and implemented.