State Member Dale Carr
State Member-
Dale Carr replied to the discussion MOU with MFCU in the forum State Only Forum a year ago
Jennifer .. I will send Missouri’s to you .. please email me at Dale.Carr@dss.mo.gov and I will respond with the MOU.
Dale Carr, Director, Missouri Medicaid Audit & Compliance
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Dale Carr replied to the discussion Administrative terminations for criminal acts not involving Medicaid in the forum State Only Forum a year ago
Reply to Administrative terminations for criminal acts not involving Medicaid
Kurt .. I have provided a link to our Missouri Medicaid provider sanctions regulation. It is somewhat broader than your state’s rules:
Missouri Secretary of State: Code of State Regulations
mo.gov)https://www.sos.mo.gov/cmsimages/adrules/csr/current/13csr/13c70-3.pdf
Look specifically at 13 CSR 70-3.030(3)(A)(32)
Best regards .. Dale Carr
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Dale Carr replied to the discussion Self Disclosures in the forum State Only Forum 2 years ago
Good morning .. Missouri does not post self-disclosures on our website.
Dale Carr
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Dale Carr started the discussion UPIC Session at NAMPI Annual Conference in the forum State Only Forum 2 years ago
UPIC Session at NAMPI Annual Conference
Fellow NAMPI Members,
The 2023 NAMPI Annual Conference in Scottsdale, AZ, is just a few weeks away and we hope you are planning to attend. One of the many great presentations will be a panel discussion on how the state Medicaid PI units can work with the Unified Program Integrity Contractors (UPICs). We have a great panel including Sherri…
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Dale Carr posted an update 2 years ago
2 years ago (edited)
Fellow NAMPI Members,
The 2023 NAMPI Annual Conference in Scottsdale, AZ, is just a few weeks away and we hope you are planning to attend. One of the many great presentations will be panel discussion on how the state Medicaid PI units can work with the Unified Program Integrity Contractors (UPICs). We have a great panel including Sherri…
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Dale Carr replied to the discussion Payment Suspension against 1 provider in group practice in the forum State Only Forum 2 years ago
Reply to Payment Suspension against 1 provider in group practice
In Missouri, we would send a full payment suspension letter to the individual practitioner and a partial payment suspension letter to the group practice for any claims where that individual practitioner was the performing/rendering provider.
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Dale Carr replied to the discussion UPIC Final Findings Report (FFR) in the forum State Only Forum 2 years ago
Reply to UPIC Final Findings Report (FFR)
Cindy – Your state should have had the opportunity to review and approve the UPIC’s Initial Findings Report (IFR) and any Revised Initial Findings Report (RIFR) after the provider being audited submitted a rebuttal to the IFR. We usually tell the UPIC after the IFR or RIFR if we are not comfortable with their findings or that we are not…
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Dale Carr replied to the discussion CMS Directed Reviews of MCEs by the UPICs in the forum State Only Forum 2 years ago
Reply to CMS Directed Reviews of MCEs by the UPICs
Meant to say Medicare, Medicaid FFS and Medicaid MCO claims .. Dale
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Dale Carr replied to the discussion CMS Directed Reviews of MCEs by the UPICs in the forum State Only Forum 2 years ago
Reply to CMS Directed Reviews of MCEs by the UPICs
I agree with Kim. Our UPIC JOA specifies that we can approve or disapprove any audits. However, our UPIC did begin conducting audits of MCO DME claims about a year ago. It is the first time they have looked at MCO encounter claims and our first time helping them get records from the MCOs. As part of their project, the UPIC is looking at…
