§ 12-15-13.5-2 — Recovery audit; contract; performance

Indiana § 12-15-13.5-2

• Jurisdiction: Indiana
• Art. 15: MEDICAID
• Ch. 13.5: Medicaid Recovery Audits

Text

(a) The office and a managed care
organization that has contracted with the office under this article shall
perform a recovery audit to ensure the integrity of the Medicaid
program.
(b) The office shall contract with a recovery auditing entity to
perform the recovery audit. A contract with a recovery auditing entity
must include the following services:
(1) Review of claims submitted by providers or other individuals
furnishing items and services for payment by the Medicaid
program to determine whether overpayment or underpayment
occurred.
(2) Recovery of identified overpayments and payment to
providers of identified underpayments.
(c) A managed care organization may either perform the recovery
audit internally or contract with a recovery auditing entity to perform
the recovery audit. A recovery audit by a managed care organization,
whether performed internally or through a contract with a recovery
auditing entity, must meet the requirements of subsection (b) and
section 3 of this chapter.

Legislative History

As added by P.L.134-2019, SEC.2.