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The document summarizes the data auditing and service review processes conducted by the Mental Health and Substance Abuse Division, including:
1) Encounter data verification reviews are conducted twice per year on a random sample of encounters to check accuracy.
2) Medicaid claims are compared to service authorizations to identify errors and annual audits check for overpayments.
3) Encounters are compared to claims to identify unbilled or unreported instances.
4) On-site quality reviews sample from data outliers and include more comprehensive elements than remote data reviews.
The document summarizes the data auditing and service review processes conducted by the Mental Health and Substance Abuse Division, including:
1) Encounter data verification reviews are con…