471 NAC 20-013. Quality Assurance and Utilization Review

013. Quality Assurance and Utilization Review. All Nebraska Medicaid providers have agreed to provide services under the requirements of this title regarding , provider agreements. If there is any question or concern about the quality of service being provided by an enrolled provider, Nebraska Medicaid may perform quality assurance and utilization review activities to verify the quality of service. If the provider or the services do not meet the standards of this chapter and the specific level of care, the provider may be subject to administrative sanctions or denial of provider agreement for good cause . Nebraska Medicaid may request a refund for all services not meeting the requirements. If beneficiaries are in immediate jeopardy, the sanctions will be imposed without a hearing.