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Medicaid Announces...

Conducting Post Payment Reviews of paid claims using AdvanceMed

Medicaid announced June 2018 that to pursuant of MCL 333.26368, Sections 14.2 and 16 of the General Information for Providers section of the Michigan Medicaid Provider Manual, and the Medical Assistance Provider Enrollment & Trading Partner Agreement, Michigan Dept of H&HS Office of Inspector General (OIG) is authorized to perform posting-payment reviews of paid Medicaid claims to identify and recover any overpayments made to Medicaid providers.

AdvanceMed will be conducting these post payment audits on behalf of MDHHS OIG, and MDHHS OIG will oversee these audit activities for the State of Michigan.

AdvanceMed will utilize statistical random sampling and extrapolation, as well as claim-specific auditing methodologies.  The audit actions may include, but are not limited to:
  • Recipient Interviews
  • Provider Interviews
  • Onsite Visits
  • Medical Records Requests
For more information, see announcement here!

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