Does the post-service, prepayment audit (PPM Audit) status affect all of a provider’s current claims in the system?
A. As explained in the Utilization Control Action Notice provider letter providers receive, the PPM Audit applies to one or more procedure codes, or to all of the provider’s claims. Medi-Cal only reviews claims for dates of services within the PPM period, regardless of when the claim was submitted. The Utilization Control Action Notice letter informs providers of the specific procedure codes affected and the date when the PPM Audit began.
Related Questions
- Who can a provider talk to for questions concerning post-service, prepayment audit (PPM Audit) documentation requirements for specific claims?
- Does the post-service, prepayment audit (PPM Audit) status affect all of a provider’s current claims in the system?
- Who can a provider talk to for other questions concerning the post-service, prepayment audit (PPM Audit) process?
