Hi all, we are wondering if your state has Administrative Code that permits recoupment based on policies and topics in your Medicaid handbooks. If so, could you please provide a link to your state’s admin code? Thank you!

Good morning! Wisconsin would be happy to share our MOU via email. Please send me your email address. Thanks!

Thank you so much Rebecca! I appreciate your answer.

We are trying to get finders’ keepers language added to our MCO contract. Our Division of Medicaid Services was concerned that either the actuaries or the contracting area of CMS may have issues with the addition of this language.

Have any other states ever had problems getting their MCO contract approved due to finders’ keepers language, or…

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Wisconsin OIG is still working with our Medicaid policy partners to try to establish recovery of network provider overpayments. We are trying to establish a finders’ keepers model with OIG recovering from the MCO and the MCO recovering from the network provider. Our partners are having difficulty visualizing how the federal reporting would work…

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Wisconsin OIG is still working with our Medicaid policy partners to try to establish recovery of network provider overpayments. We are trying to establish a finders’ keepers model with OIG recovering from the MCO and the MCO recovering from the network provider. Our partners are having difficulty visualizing how the federal reporting would work…

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Wisconsin OIG is looking to partner with its Medicaid partners to explore utilization review particularly the exploration of underutilization resulting in emergency room visits or hospital stays for the patient. We are curious about any PI initiatives other states have going regarding utilization management. Thank you!

Hi All,

Wisconsin is looking to gather some information about how other states are addressing balance billing in fee-for-service, managed care, and HCBS waiver programs. Thank you in advance for any information you can provide.

Wisconsin is interested in learning more about any benchmarks or performance measures that other states have put into their MCO contracts. We would be interested in understanding whether you use a “one-size-fits-all” approach when it comes to these benchmarks or if you use a formula to account for the difference in number of members served by…

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Hi Jennifer, which UPIC do you partner with? Thanks!

Hi All, Wisconsin is looking to expand our hospital audits. Could you please provide a description of any hospital audits your state conducts that you’ve found to have a good return on investment? Please also indicate if you are willing to receive emails from our team with additional questions. Thank you!

Thank you all for your responses. I appreciate your assistance as we continue to move our proposal forward. I have attached a spreadsheet with all of the responses here.

Hi Jennifer,

I did receive Kentucky’s information. Thank you!

Wisconsin is considering adding staff and creating a specific section within its OIG to focus solely on managed care program integrity. In considering this request, leadership is inquiring how our sister states structure their Medicaid OIGs or program integrity units.

Would you mind taking a few moments to complete the survey below? It…

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