Perform detection and normative benchmarking of use, cost, 727. PIB54 and treatment patterns using clinically and analytically defensible provider grouping and profiling methodologies. Withhold provider payments, as directed by CHFS, or its 728. PIB55 designee. Refer evidence or reports/information of provider fraud or 729. abuse to CHFS, or its designee. Respond to Commonwealth requests for general information 730. PIB57 about the reports/information, within a timeframe specified by DMS. When reporting deficiencies are identified and substantiated, 731. PIB58 correct the problem, get DMS approval, and rerun the report, within a timeframe specified by DMS. Meet Federal and Commonwealth requirements for SUR, as 732. PIB59 outlined in Program Integrity Regulations. CUSTOMER RELATIONS (CS) Operate and maintain the Automated Eligibility Verification 733. CSB1 System (AEVS) function of the MEMS, for Kentucky Medicaid providers to verify member eligibility. Provide a voice messaging system for after hour callers stating hours of operation and providing options for callers to 734. CSB2 leave messages. Full message script to be approved by CHFS, or its designee. Provide a voice messaging option, at CHFS, or its designee, 735. CSB3 designated intervals, during the queue hold time. Provide appropriate staff levels to support this function. 736. CSB4
727. PIB54 Perform detection and normative benchmarking of use, cost, and treatment patterns using clinically and analytically defensible provider grouping and profiling methodologies. 728. PIB55 Withhold provider payments, as directed by CHFS, or its designee. 729. Refer evidence or reports/information of provider fraud or abuse to CHFS, or its designee. 730. PIB57 Respond to Commonwealth requests for general information about the reports/information, within a timeframe specified by DMS. 731. PIB58 When reporting deficiencies are identified and substantiated, correct the problem, get DMS approval, and rerun the report, within a timeframe specified by DMS. 732. PIB59 Meet Federal and Commonwealth requirements for SUR, as outlined in Program Integrity Regulations. CUSTOMER RELATIONS (CS) 733. CSB1 Operate and maintain the Automated Eligibility Verification System (AEVS) function of the MEMS, for Kentucky Medicaid providers to verify member eligibility. 734. CSB2 Provide a voice messaging system for after hour callers stating hours of operation and providing options for callers to leave messages. Full message script to be approved by CHFS, or its designee. 735. CSB3 Provide a voice messaging option, at CHFS, or its designee, designated intervals, during the queue hold time. 736. CSB4 Provide appropriate staff levels to support this function.
Attachment_I_-_MEMS_Fiscal_Agent_Requirements[1].docx