FY14 POST-PAYMENT REVIEW TOOL

FY14 POST-PAYMENT REVIEW TOOL
A. PROVIDER NAME: B. REVIEW DATE: Dates of on-site review
C. PROVIDER #:  Collaborative provider/NPI D. Time Period Covered: Date span for bills reviewed.
All claims reviewed will have been processed and approved by DHS/HFS. The claim review period is the 12 month period
prior to the PPR.

CONTRACT AND RULE COMPLIANCE

Reason Codes:

  1. No valid note documenting the service could be located.
  2. Note describes a service intervention or activity that is not billable.
  3. Service provided by unqualified staff.
  4. No amount of time documented.
  5. No valid Mental Health Assessment could be located.
  6. No valid Individual Treatment Plan could be located.
  7. Specific service does not appear on ITP.
  8. ITP review does not demonstrate both a review of progress towards goals and an evaluation of needed services.
  9. Time billed is greater than time documented.
  10. Location of service not correctly noted on-site vs. off-site.
  11. Note describes a different service than billing submitted. 
     COMMENTS:
    Reviewer comments of any other positives or concerns identified during the review
Quality Indicators  Yes / No
A. Documentation is sufficiently detailed corresponding to time billed. 
B. MHA contains sufficiently detailed information to guide clinical treatment.
COMMENTS:
Reviewer comments of any other positives or concerns identified during the review. 

Reviewer: _____________________________________________ Date__________________

Reviewer: _____________________________________________ Date_________________


Results verbally reviewed with provider and copy of summary provided to:

Name: _____________________________________________ Date___________________

  • Signature of Provider Representative


A copy of this summary document is left with the Provider