Why are Medi-Cal claims subject to a post-service, prepayment audit (PPM Audit)?
A. The California Code of Regulations (CCR), Title 22, Section (22 CCR ยง) 51460 states: “Special Claims Review may be imposed on a provider upon a determination that the provider has submitted improper claims, including claims which incorrectly identify or code services provided.” Providers receive a Utilization Control Action Notice provider letter with a detailed explanation concerning problems found with a claim based on the audit.
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?
- Why are Medi-Cal claims subject to a post-service, prepayment audit (PPM Audit)?
