LAC 50:I.4203. Claims Review

A. The department may require a provider’s claims be subject to a pre-payment or post-payment review. B. The decision to implement a pre-payment or post-payment review is not a sanction, cannot be appealed, and is not subject to an informal hearing. C. Pre-payment and post-payment review may be limited to specific items or procedures. It may also include all billings or claims a provider submits. D. The duration a provider is on pre-payment or post-payment review shall be at the discretion of the BHSF director or the PIU section chief. E. A department assessed sanction resulting from a post-payment review is appealable and subject to an informal hearing.