Document Category: Family and Children’s Medicaid

2023 – 2024 County Internal Inspection Schedule

I. INTRODUCTION II. REQUIREMENTS III. PROCEDURES IV. FINANCIAL RESPONSIBILITY Medicaid Procedures for Requesting Corrections – DSS Support Unit

I. PURPOSE II. LEGAL RESPONSIBILITY AND REFERENCES III. NORTH CAROLINA GENERAL STATUTES IV. FRAUD VS. MISREPRESENTATION V. PREVENTION VI. DETECTION VII. INVESTIGATIONS VIII. CALCULATING OVERPAYMENTS IX. NORTH CAROLINA HEALTH CHOICE OVERPAYMENTS X. CONCLUSIONS AND RECOMMENDATIONS XI. NOTICES & APPEALS XII. ADMINISTRATIVE COLLECTION PROCEDURES XIII. BANKRUPTCY XIV. DISTRIBUTION OF CASH REPAYMENT XV. EPICS REPORTING REQUIREMENTS XVI.…

I. INTRODUCTION II. POLICY PRINCIPLES III. PHYSICIAN SERVICES IV. CLINIC SERVICES V. HOSPITAL INPATIENT SERVICES VI. HOSPITAL OUTPATIENT SERVICES VII. NURSING FACILITY SERVICES VIII. PSYCHIATRIC AND PSYCHOLOGICAL SERVICES IX. RESIDENTIAL SERVICES X. MENTAL HEALTH CENTERS XI. STATE AND PRIVATE MENTAL HOSPITALS XII. NORTH CAROLINA SPECIALTY HOSPITALS XIII. DENTAL SERVICES XIV. CHIROPRACTORS XV. PODIATRISTS XVI. HOSPICE…

I. Introduction II. PROCEDURES

I. POLICY RULES II. PROCEDURES III. TYPES OF THIRD PARTY RESOURCES IV. INTERVIEW QUESTIONS FOR DETERMINING TYPES OF THIRD PARTY RESOURCES V. MEDICAID AS PAYER OF LAST RESORT OR AS PRIMARY PAYER VI. THIRD PARTY RECOVERY NON COMPLIANCE VII. THIRD PARTY INSURANCE FOR NCHC AND BCCM Additions/Terminations/Changes to Third Party Insurance Listserv (August 10, 2020)

I. INTRODUCTION II. BENEFIT VERIFICATION III. MANUAL VERIFICATION OF BENEFITS IV. THE SOLQ/TPQY SYSTEM V. DOCUMENTATION