Can a provider appeal being placed on post-service, prepayment audit (PPM Audit)?
A. DHCS may audit Medi-Cal claims at any time; providers do not have the right to appeal the DHCS decision to conduct the audit. The PPM Audit is one of the utilization controls established by W&I Code § 14133(b). DHCS procedures for the PPM Audit are prescribed by 22 CCR § 51460. Neither section provides an appeal right for providers.
Related Questions
- Who can a provider talk to for questions concerning post-service, prepayment audit (PPM Audit) documentation requirements for specific claims?
- How can a provider appeal a specific claim denied by the post-service, prepayment audit (PPM Audit)?
- Can a provider appeal being placed on post-service, prepayment audit (PPM Audit)?
