practice/organization, enrollment status, facility type, geographic location, billing versus performing providers, and size or any combinations thereof, for the purpose of developing statistical profiles. Provide a proven statistical methodology to classify and reclassify treatment into user-defined groups, by diagnosis 701. PIB28 code, drug code, procedure code, episode of care, groups or ranges of codes, geographical region, or combination thereof, for the purpose of developing statistical profiles. Maintain an enhanced peer grouping/advanced fraud 702. detection solution, including CMS Certification as a SUR/FAD. Conduct comprehensive and systematic ongoing review of the KY Medicaid Program utilization, as well as targeted or 703. PIB30 focused reviews, profiles, and specialized analyses and decision support services, as requested by CHFS, or its designee. 704. PIB31 Receive claim detail requests from CHFS, or its designee. Produce and deliver claim detail reports/information, and 705. PIB32 provider and member profiles, in the timeframe, format, and media requested by CHFS, or its designee. Use standard report naming conventions, as defined by 706. PIB33 CHFS, or its designee. Provide reports related to FAD. Also, provide reports/information related to PI that include, but are not limited to: 707. PIB34 Ranking reports. Exception reports. Control file reports.
practice/organization, enrollment status, facility type, geographic location, billing versus performing providers, and size or any combinations thereof, for the purpose of developing statistical profiles. 701. PIB28 Provide a proven statistical methodology to classify and reclassify treatment into user-defined groups, by diagnosis code, drug code, procedure code, episode of care, groups or ranges of codes, geographical region, or combination thereof, for the purpose of developing statistical profiles. 702. Maintain an enhanced peer grouping/advanced fraud detection solution, including CMS Certification as a SUR/FAD. 703. PIB30 Conduct comprehensive and systematic ongoing review of the KY Medicaid Program utilization, as well as targeted or focused reviews, profiles, and specialized analyses and decision support services, as requested by CHFS, or its designee. 704. PIB31 Receive claim detail requests from CHFS, or its designee. 705. PIB32 Produce and deliver claim detail reports/information, and provider and member profiles, in the timeframe, format, and media requested by CHFS, or its designee. 706. PIB33 Use standard report naming conventions, as defined by CHFS, or its designee. 707. PIB34 Provide reports related to FAD. Also, provide reports/information related to PI that include, but are not limited to: Ranking reports. Exception reports. Control file reports.