42 CFR 456.23 : Public Health (Part 1 To Parts 1009-1099) — (§ 430.0 To Part 481) — Centers For Medicare & Medicaid Services, Department Of Health And Human Services (Continued) (§ 430.0 To Part 481) — Medical Assistance Programs (§ 430.0 To § 456.725) — Utilization Control (§ 456.1 To § 456.725) — Utilization Control: All Medicaid Services (§ 456.21 To § 456.23) — Post-payment review process.

4 Aug 2016

The agency must have a post-payment review process that -

(a) Allows State personnel to develop and review -

(1) Beneficiary utilization profiles;

(2) Provider service profiles; and

(3) Exceptions criteria; and

(b) Identifies exceptions so that the agency can correct misutilization practices of beneficiaries and providers.

42 CFR 456.23