Education-awareness letters to the Medicaid provider community

Abstract

SCDHHS currently does not have a process in place for making providers aware of their billing anomalies without conducting a review/audit of them. SCDHHS needs an effective process for sending education letters to members of the South Carolina Medicaid Provider community with atypical billing patterns and for tracking the impact of the letters on the providers’ future billing behavior. The goal is to have data mining carry the weight of this project by utilizing minimal resources and time. implementing this proposed process of sending education letters to address the providers’ billing behavior, will allow the Division of Program Integrity to monitor the behavior without conducting a comprehensive review and investigation. This, in turn, will benefit the department as it will be counted as a cost avoidance measure using minimal manpower and resources, which will result in better outcomes and save on provider reimbursements.