Who can a provider talk to for questions concerning post-service, prepayment audit (PPM Audit) documentation requirements for specific claims?
The documentation and certifying statement requirments are listed on the 20+ page letter you receive from DHCS notifying you when you are to begin your SCR – PPM. It is a general letter that outlines the requirments for ALL provider types and can be burdensome to read and interpret. You can call the SCR-PPM Analyst at Equitable Solutions for a much faster answer. On average it can take up to two weeks or more for a return call when leaving a message through TSC. We maintain contacts and direct numbers for all of the key individuals within the regulatory agencies, and have developed checklists and "cheat sheets" to aid in making sense of the manual claims submission process and requirements. If you have the right help, a SCR – PPM claims recovery ration of 97% is a very attainable goal.
"Had it not been for Equitable Solutions I strongly believe we would not have survived as a Medi-Cal provider. We plan to use them in the future to spot check our documentation and would recommend them to anyone having problems with Medi-cal."
Marina Shabum, Adult Day Health Care Center Owner
For more information, please visit http://www.scr-ppm.com/
Related Questions
- Who can a provider talk to for questions concerning post-service, prepayment audit (PPM Audit) documentation requirements for specific claims?
- Who can a provider talk to for other questions concerning the post-service, prepayment audit (PPM Audit) process?
- How can a provider appeal a specific claim denied by the post-service, prepayment audit (PPM Audit)?
