TITLE 42 - PUBLIC HEALTH

CHAPTER IV - CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER C - MEDICAL ASSISTANCE PROGRAMS

PART 431 - STATE ORGANIZATION AND GENERAL ADMINISTRATION

subpart q - REQUIREMENTS FOR ESTIMATING IMPROPER PAYMENTS IN MEDICAID AND SCHIP

431.970 - Information submission requirements.

States must submit information to the Secretary for, among other purposes, estimating improper payments in Medicaid and SCHIP, that include but are not limited to (a) Claims data and annual expenditures from previous year; (b) Quarterly, stratified adjudicated claims data from the review year; (c) All medical and other policies in effect and quarterly updates as needed to perform claims reviews; (d) Data processing systems manuals; (e) Current provider contact information that is verified and/or updated to contain current provider contact information; (f) Repricing information for claims that are determined to be improperly paid; (g) Other information that the Secretary determines is necessary for, among other purposes, estimating improper payments and determining error rates in Medicaid and SCHIP, and (h) A corrective action report as prescribed by the Secretary for purposes of reducing the payment error rate.