State Member Matilda Kruse
State Member-
Matilda Kruse replied to the discussion Scope of Work Examples for Utilization Review Nurse & PI Investigator in the forum State Only Forum 2 weeks ago
Reply to Scope of Work Examples for Utilization Review Nurse & PI Investigator
Sorry, I forgot to put in my original message. If it’s not available as a link, could you please email the position description and scope of work examples to matilda.kruse@medicaid.as.gov. Thank you!
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Matilda Kruse started the discussion Scope of Work Examples for Utilization Review Nurse & PI Investigator in the forum State Only Forum 2 weeks ago
Scope of Work Examples for Utilization Review Nurse & PI Investigator
With the new program changes and increased focus of PI at a national level, our agency is looking to expand our PI division and include these new positions in our new budget request for FY 2027. We are looking to hire a Utilization Review Nurse and more PI Investigators/auditors/reviewers. Any information you can provide on your agency’s…
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Matilda Kruse started the discussion Overpayment Demand Letter Template/Format in the forum State Only Forum 3 years ago
Overpayment Demand Letter Template/Format
Our public hospital provider has notified the agency of an overpayment made in their monthly reimbursements. We are currently in the process to recoup the overpayment. CMS Region IX Finance was also informed and alerted by our Medicaid Finance Division Head.
Our finance division has already worked on a monthly payment plan in order to refund…
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Matilda Kruse replied to the discussion OIG/PI Unit Composition in the forum State Only Forum 4 years ago
Reply to OIG/PI Unit Composition
Apologies for the delay.Apologies for the delay. Please find below the responses for American Samoa (AS).
1. Number of managed care recipients. AS is 100% fee-for-service.
2. Number of fee-for-service recipients. 31,434*
3. Number of MCOs. N/A
4. Number of full-time employees (FTE) in OIG PI Unit. 2 FTEs
5. Number of FTE assigned to managed care…
