Reimbursement

Reimbursement A. Claims must be based on services that have been rendered to beneficiaries as authorized by the Plan of Services and Supports (PSS), accurately billed by qualified waiver providers, and in accordance with the approved waiver. B. The Division of Medicaid conducts financial audits of waiver providers. If warranted, immediate action is taken to address compliance or financial discrepancies. C. The Division of Medicaid denies payment for services when a beneficiary or applicant is not Medicaid eligible on the date of service. D. The Division of Medicaid conducts post utilization reviews to ensure the services provided were on the beneficiary’s approved PSS. E. Records documenting the provision of services must be maintained by the providers of waiver services for a minimum of five (5) years. If, at the conclusion of the five-year period, there is ongoing litigation or an open audit, the provider must maintain these records until the litigation or audit is concluded. F. Payment for all waiver services is made through an approved Medicaid Management Information System (MMIS). G. Providers must bill for Assisted Living (AL) Waiver services no sooner than the first (1st) day of the month following the month in which services were rendered. H. Transportation is an integral part of AL Waiver provider services and is not reimbursed separately.